Provider Demographics
NPI:1376833848
Name:AYOUB, SAMIA B
Entity Type:Individual
Prefix:DR
First Name:SAMIA
Middle Name:B
Last Name:AYOUB
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:SAMIA
Other - Middle Name:
Other - Last Name:BOTROUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2080 HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1090
Mailing Address - Country:US
Mailing Address - Phone:732-671-0011
Mailing Address - Fax:732-671-2564
Practice Address - Street 1:2080 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1090
Practice Address - Country:US
Practice Address - Phone:732-671-0011
Practice Address - Fax:732-671-2564
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA064916208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7386508Medicaid