Provider Demographics
NPI:1013538917
Name:ALYACOUB, LEEN HOSAM (MBBS)
Entity type:Individual
Prefix:MS
First Name:LEEN
Middle Name:HOSAM
Last Name:ALYACOUB
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22207 CEDAR DR APT 22207
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-1267
Mailing Address - Country:US
Mailing Address - Phone:716-994-5943
Mailing Address - Fax:
Practice Address - Street 1:2333 WHITEHORSE MERCERVILLE RD STE 3
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-1946
Practice Address - Country:US
Practice Address - Phone:609-890-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-01
Last Update Date:2025-08-12
Deactivation Date:2022-01-11
Deactivation Code:
Reactivation Date:2023-06-26
Provider Licenses
StateLicense IDTaxonomies
NJ25MA12487600207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA12487600OtherNJ LICENSE