1215194352 NPI number — MR. NABIL YACOUB YOUNAN MD

Table of content: MR. NABIL YACOUB YOUNAN MD (NPI 1215194352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215194352 NPI number — MR. NABIL YACOUB YOUNAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNAN
Provider First Name:
NABIL
Provider Middle Name:
YACOUB
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215194352
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 CANDLEWOOD DRIVE
Provider Second Line Business Mailing Address:
SEASHORE ANESTHESIA
Provider Business Mailing Address City Name:
LINWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-927-7273
Provider Business Mailing Address Fax Number:
609-927-7273

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 CANDLEWOOD DRIVE
Provider Second Line Business Practice Location Address:
SEASHORE ANESTHESIA
Provider Business Practice Location Address City Name:
LINWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-927-7273
Provider Business Practice Location Address Fax Number:
609-927-7273
Provider Enumeration Date:
05/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207LA0401X , with the licence number:  MA027653 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 780222355000 . This is a "HORIZON BCBS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3027309 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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