Provider Demographics
NPI:1043598246
Name:YESUKEVICH, CHRISTOPHER ALLEN (IDC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:ALLEN
Last Name:YESUKEVICH
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82A WOODLAND RD
Mailing Address - Street 2:APT 4
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078-2400
Mailing Address - Country:US
Mailing Address - Phone:847-208-6259
Mailing Address - Fax:
Practice Address - Street 1:82A WOODLAND RD
Practice Address - Street 2:APT 4
Practice Address - City:SHORT HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07078-2400
Practice Address - Country:US
Practice Address - Phone:847-208-6259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman