Healthcare Provider Details

I. General information

NPI: 1184042277
Provider Name (Legal Business Name): MARYAM M. YASSA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2014
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PLAINSBORO RD DEPT OF
PLAINSBORO NJ
08536-1913
US

IV. Provider business mailing address

1 PLAINSBORO RD DEPT OF
PLAINSBORO NJ
08536-1913
US

V. Phone/Fax

Practice location:
  • Phone: 609-853-7000
  • Fax:
Mailing address:
  • Phone: 609-853-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number25MA11625300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: