Provider Demographics
NPI:1982701512
Name:YOUSUF, ATM (MD)
Entity type:Individual
Prefix:DR
First Name:ATM
Middle Name:
Last Name:YOUSUF
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 1:3 LIVINGSTON PL
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-7817
Mailing Address - Country:US
Mailing Address - Phone:516-728-7000
Mailing Address - Fax:718-205-6564
Practice Address - Street 1:3729 72ND ST FL 1
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6126
Practice Address - Country:US
Practice Address - Phone:718-205-6633
Practice Address - Fax:717-205-6564
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212144207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01916150Medicaid
NY04078Medicare ID - Type Unspecified
NYH03485Medicare UPIN