Healthcare Provider Details

I. General information

NPI: 1467895706
Provider Name (Legal Business Name): YASMEN ATEF SROUR M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 WASHINGTON ST
BLOOMFIELD NJ
07003-3412
US

IV. Provider business mailing address

613 PARK AVE FL 2
EAST ORANGE NJ
07017-1905
US

V. Phone/Fax

Practice location:
  • Phone: 973-672-8573
  • Fax: 973-675-0040
Mailing address:
  • Phone: 973-672-8573
  • Fax: 973-675-0040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA10485500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0082214
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: