Healthcare Provider Details

I. General information

NPI: 1679983605
Provider Name (Legal Business Name): YAZAN ABDEEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 CENTRAL AVE
NEWARK NJ
07102-1909
US

IV. Provider business mailing address

6 PATTON DR
BLOOMFIELD NJ
07003-5216
US

V. Phone/Fax

Practice location:
  • Phone: 973-877-5485
  • Fax:
Mailing address:
  • Phone: 908-422-6063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number25MA09388600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25MA09388600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: