Provider Demographics
NPI:1316007651
Name:YASIN, SAMI F (MD)
Entity Type:Individual
Prefix:
First Name:SAMI
Middle Name:F
Last Name:YASIN
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 1:199 STATE RT 284
Mailing Address - Street 2:
Mailing Address - City:WANTAGE
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
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197792-1207R00000X, 207RI0200X
NJ25MA05330800207RI0200X, 207R00000X, 207R00000X
MI4301087529207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ342010801Medicaid
NY01496762Medicaid
NJCI4224OtherRAILROAD MEDICARE
NY753743Medicare ID - Type Unspecified
NJE29949Medicare UPIN
NJ584168Medicare ID - Type Unspecified