Provider Demographics
NPI:1124223722
Name:MANSOUR, AYMAN MOHAMMED OMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:AYMAN
Middle Name:MOHAMMED OMAR
Last Name:MANSOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 MAYFAIR CT
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-6361
Mailing Address - Country:US
Mailing Address - Phone:609-495-4826
Mailing Address - Fax:877-916-2892
Practice Address - Street 1:40 MAYFAIR CT
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-6361
Practice Address - Country:US
Practice Address - Phone:609-495-4826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD448187208000000X
NJ25MA083602208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics