Provider Demographics
NPI:1851057194
Name:YOUSSEF, DEREK JAMES (DVM)
Entity type:Individual
Prefix:DR
First Name:DEREK JAMES
Middle Name:
Last Name:YOUSSEF
Suffix:
Gender:M
Credentials:DVM
Other - Prefix:
Other - First Name:TAREK
Other - Middle Name:OMAR
Other - Last Name:YOUSSEF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DVM
Mailing Address - Street 1:502 VAN BUSSUM AVE APT 113
Mailing Address - Street 2:
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-6171
Mailing Address - Country:US
Mailing Address - Phone:212-810-0193
Mailing Address - Fax:212-810-0194
Practice Address - Street 1:2143 ADAM CLAYTON POWELL JR BLVD
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-3008
Practice Address - Country:US
Practice Address - Phone:212-280-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013636-1208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty