Provider Demographics
NPI:1760719967
Name:KINGSBERY, MINA YASSAEE (MD)
Entity Type:Individual
Prefix:
First Name:MINA
Middle Name:YASSAEE
Last Name:KINGSBERY
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 1:199 BALDWIN RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-2043
Mailing Address - Country:US
Mailing Address - Phone:973-335-2560
Mailing Address - Fax:973-335-9421
Practice Address - Street 1:199 BALDWIN RD
Practice Address - Street 2:SUITE 230
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-2043
Practice Address - Country:US
Practice Address - Phone:973-335-2560
Practice Address - Fax:973-335-9421
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-09
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY260007207N00000X
NJ25MA09262600207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology