Provider Demographics
NPI:1629825302
Name:IMBERT JULIAO, YASSER (MD)
Entity type:Individual
Prefix:DR
First Name:YASSER
Middle Name:
Last Name:IMBERT JULIAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:656 N INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-2910
Mailing Address - Country:US
Mailing Address - Phone:917-239-5587
Mailing Address - Fax:
Practice Address - Street 1:4222 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-4502
Practice Address - Country:US
Practice Address - Phone:718-960-9000
Practice Address - Fax:718-960-3272
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty