1376540831 NPI number — ROGER S YANG MD

Table of content: ROGER S YANG MD (NPI 1376540831)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376540831 NPI number — ROGER S YANG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YANG
Provider First Name:
ROGER
Provider Middle Name:
S
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:
1376540831
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
579A CRANBURY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST BRUNSWICK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08816-5426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-390-0040
Provider Business Mailing Address Fax Number:
732-390-1856

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16 MOUNTAIN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07059-5614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-769-7200
Provider Business Practice Location Address Fax Number:
908-769-9141
Provider Enumeration Date:
06/30/2005

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: 2085R0202X , with the licence number:  25MA06951400 , 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: 300129443 . This is a "RAILROAD MEDICARE - EDISON" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 8506205 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300129443 . This is a "RAILROAD MEDICARE - BRIDGEWATER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 300129443 . This is a "RAILROAD MEDICARE - WARREN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 300129443 . This is a "RAILROAD MEDICARE - SMC" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".