Provider Demographics
NPI:1962631770
Name:YOUSEFNEJADKORORI, EMIL (DDS)
Entity type:Individual
Prefix:
First Name:EMIL
Middle Name:
Last Name:YOUSEFNEJADKORORI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89- 02, 165 STREET
Mailing Address - Street 2:SUITE MW29
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432
Mailing Address - Country:US
Mailing Address - Phone:718-657-4838
Mailing Address - Fax:718-657-0099
Practice Address - Street 1:89- 02, 165 STREET
Practice Address - Street 2:SUITE MW29
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432
Practice Address - Country:US
Practice Address - Phone:718-657-4838
Practice Address - Fax:718-657-0099
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0503701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02360025Medicaid