1184824690 NPI number — YITZHAK BELSH MD

Table of content: YITZHAK BELSH MD (NPI 1184824690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184824690 NPI number — YITZHAK BELSH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BELSH
Provider First Name:
YITZHAK
Provider Middle Name:
Provider Name Prefix Text:
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:
1184824690
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3998 FAIR RIDGE DR
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22033-2907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-295-9360
Provider Business Mailing Address Fax Number:
703-766-9725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 DIAMOND HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERKELEY HEIGHTS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07922-2104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-277-8872
Provider Business Practice Location Address Fax Number:
908-673-7382
Provider Enumeration Date:
07/23/2007

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: 207L00000X , with the licence number:  243786-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 25MA08686000 , 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: 0230341 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".