Healthcare Provider Details

I. General information

NPI: 1205935509
Provider Name (Legal Business Name): YASSIN PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 01/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 LACEY ROAD
FORKED RIVER NJ
08731-0537
US

IV. Provider business mailing address

PO BOX 537
FORKED RIVER NJ
08731-0537
US

V. Phone/Fax

Practice location:
  • Phone: 609-971-0010
  • Fax: 609-242-1906
Mailing address:
  • Phone: 609-971-0010
  • Fax: 609-242-1906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA42926
License Number StateNJ

VIII. Authorized Official

Name: MAHMOUD YASSIN
Title or Position: OWNER
Credential:
Phone: 609-971-0010