Provider Demographics
NPI:1467895706
Name:SROUR, YASMEN ATEF (MD)
Entity Type:Individual
Prefix:
First Name:YASMEN
Middle Name:ATEF
Last Name:SROUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 JACK MARTIN
Mailing Address - Street 2:SUITE 6 / 2ND FLOOR
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7724
Mailing Address - Country:US
Mailing Address - Phone:732-785-1000
Mailing Address - Fax:732-785-1222
Practice Address - Street 1:459 JACK MARTIN
Practice Address - Street 2:SUITE 6 / 2ND FLOOR
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-7724
Practice Address - Country:US
Practice Address - Phone:732-785-1000
Practice Address - Fax:732-785-1222
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0082214207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD542385YWV2Medicare PIN
MD542397ZDDBMedicare PIN
MD542397YVZMedicare PIN