Provider Demographics
NPI:1063386407
Name:WANIS, YASSER ESHAK SR
Entity type:Individual
Prefix:MR
First Name:YASSER
Middle Name:ESHAK
Last Name:WANIS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6738 73RD PL MIDDLE VILLAGE
Mailing Address - Street 2:APT 2
Mailing Address - City:QUEENS
Mailing Address - State:NY
Mailing Address - Zip Code:11379
Mailing Address - Country:US
Mailing Address - Phone:929-422-8301
Mailing Address - Fax:
Practice Address - Street 1:6738 73RD PL MIDDLE VILLAGE
Practice Address - Street 2:APT 2
Practice Address - City:QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11379
Practice Address - Country:US
Practice Address - Phone:929-422-8301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP128085224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant