Provider Demographics
NPI:1053330647
Name:YRAD, JONATHAN P (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:P
Last Name:YRAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:478 BRICK BLVD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-6077
Mailing Address - Country:US
Mailing Address - Phone:732-701-4848
Mailing Address - Fax:732-701-1469
Practice Address - Street 1:478 BRICK BLVD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-6077
Practice Address - Country:US
Practice Address - Phone:732-701-4848
Practice Address - Fax:732-701-1469
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07733700208600000X
NJ25MA077337000207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0043842Medicaid
NJI15579Medicare UPIN
NJ0043842Medicaid
NJP00159512Medicare PIN