Provider Demographics
NPI:1124287412
Name:YESHOU, DIMA (MD)
Entity type:Individual
Prefix:
First Name:DIMA
Middle Name:
Last Name:YESHOU
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 1:560 CLINTON RD
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-4738
Mailing Address - Country:US
Mailing Address - Phone:201-967-8425
Mailing Address - Fax:201-263-4665
Practice Address - Street 1:12-04 SADDLE RIVER RD
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-5811
Practice Address - Country:US
Practice Address - Phone:201-773-8710
Practice Address - Fax:201-773-8711
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241486207RE0101X
NJ25MA08384100207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0190861Medicaid
NJ143089Medicare PIN