Provider Demographics
NPI:1023569027
Name:YELENA BIRGER DO PC
Entity Type:Organization
Organization Name:YELENA BIRGER DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-333-0062
Mailing Address - Street 1:12 WALDEN CT
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3573
Mailing Address - Country:US
Mailing Address - Phone:732-360-0619
Mailing Address - Fax:
Practice Address - Street 1:300 CRAIG RD STE 208
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8742
Practice Address - Country:US
Practice Address - Phone:732-333-0062
Practice Address - Fax:732-333-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-14
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07663700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty