Provider Demographics
NPI:1295802965
Name:YUSUF, FAZLUL HAMID (MD)
Entity type:Individual
Prefix:DR
First Name:FAZLUL
Middle Name:HAMID
Last Name:YUSUF
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 1:5707 146TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5322
Mailing Address - Country:US
Mailing Address - Phone:718-461-8625
Mailing Address - Fax:718-461-8628
Practice Address - Street 1:5707 146TH ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5322
Practice Address - Country:US
Practice Address - Phone:718-461-8625
Practice Address - Fax:718-461-8628
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1918062080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY014978896Medicaid
NY014978896Medicaid