Provider Demographics
NPI:1083633135
Name:SAMI F. YASIN MD PC
Entity Type:Organization
Organization Name:SAMI F. YASIN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:YASIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-875-7121
Mailing Address - Street 1:199 STATE RT 284
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:NJ
Mailing Address - Zip Code:07461-3417
Mailing Address - Country:US
Mailing Address - Phone:973-875-7121
Mailing Address - Fax:973-875-7123
Practice Address - Street 1:199 STATE RT 284
Practice Address - Street 2:
Practice Address - City:WANTAGE
Practice Address - State:NJ
Practice Address - Zip Code:07461-3417
Practice Address - Country:US
Practice Address - Phone:973-875-7121
Practice Address - Fax:973-875-7123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05330800207RI0200X
NY197792-1207RI0200X
MI4301087529207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1054395OtherHORIZON MERCY
NY01496762Medicaid
NY753743Medicare ID - Type Unspecified
NY01496762Medicaid