Provider Demographics
NPI:1205914256
Name:AYOUB PEDIATRICS PA
Entity type:Organization
Organization Name:AYOUB PEDIATRICS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:AYOUB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-671-0011
Mailing Address - Street 1:2080 STATE HIGHWAY #35
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733
Mailing Address - Country:US
Mailing Address - Phone:732-671-0011
Mailing Address - Fax:732-671-2564
Practice Address - Street 1:2080 STATE HIGHWAY #35
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733
Practice Address - Country:US
Practice Address - Phone:732-671-0011
Practice Address - Fax:732-671-2564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA064916208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7386508Medicaid
G54675Medicare UPIN