Provider Demographics
NPI:1134117625
Name:RADUCANU, YARON (DPM)
Entity Type:Individual
Prefix:DR
First Name:YARON
Middle Name:
Last Name:RADUCANU
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 CHRIS GAUPP DR STE 300
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4489
Mailing Address - Country:US
Mailing Address - Phone:609-404-0700
Mailing Address - Fax:609-404-0712
Practice Address - Street 1:408 CHRIS GAUPP DR STE 300
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4489
Practice Address - Country:US
Practice Address - Phone:609-404-0700
Practice Address - Fax:609-404-0712
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00322800213E00000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0466867Medicaid