Provider Demographics
NPI:1396755898
Name:YASMEEN, GHAZALA (MD)
Entity type:Individual
Prefix:DR
First Name:GHAZALA
Middle Name:
Last Name:YASMEEN
Suffix:
Gender:F
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:PO BOX 1555
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11582-1555
Mailing Address - Country:US
Mailing Address - Phone:516-285-4356
Mailing Address - Fax:516-285-4357
Practice Address - Street 1:300 STUART AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-1055
Practice Address - Country:US
Practice Address - Phone:516-285-4356
Practice Address - Fax:516-285-4357
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226257207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1568640175OtherNPI
NY02349255Medicaid
NY07160HMedicare PIN
NY1568640175OtherNPI
NY95S071Medicare PIN
NY119SP1Medicare PIN
NY1568640175Medicare NSC
NY07160Medicare PIN
119SPEZ791Medicare PIN