| Doctor Name: | ETHEL MIRIAM IUSIM |
| NPI Number: | 1205066362 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | 191660 |
| Business Practice Address: | 95-55 Roosevelt Ave Jackson Heights, NY - 11372 |
| Business Phone Number: | 7184787272 |
| Business Fax Number: | 7184786455 |
| Mailing Address: | 95-55 Roosevelt Ave, JACKSON HEIGHTS |
| State: | NY |
| Postal Code: | 11372 |
| Phone Number: | 7184787272 |
| Fax Number: | 7184786455 |
| NPI Enumeration Date: | 07/22/2009 |
| NPI Last Update Date: | 07/28/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 191660 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |