Active NPI
Youssef Ibrahim
- Physical Therapy Assistant
- Ronkonkoma, NY
National Provider Identifier
1306783444
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 015387
- Practice address
- 374 Port Ave
Ronkonkoma, NY 11779-4815 - Phone
- (917) 517-6339
- NPI assigned
- Apr 29, 2026
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 015387 | NY | Primary |
Addresses
Primary practice location
374 Port Ave
Ronkonkoma, NY 11779-4815
Mailing address
374 Port Ave
Ronkonkoma, NY 11779-4815
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 015387 | NY | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1777420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1777420800000",
"number": "1306783444",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "374 PORT AVE",
"city": "RONKONKOMA",
"state": "NY",
"postal_code": "117794815"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "374 PORT AVE",
"city": "RONKONKOMA",
"state": "NY",
"postal_code": "117794815",
"telephone_number": "917-517-6339"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IBRAHIM",
"first_name": "YOUSSEF",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2026-04-29",
"last_updated": "2026-04-29",
"certification_date": "2026-04-29",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physical Therapy Assistant",
"state": "NY",
"license": "015387",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ronkonkoma, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.