Provider Demographics
NPI:1164741641
Name:YELLIN, MICHAEL JAY (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JAY
Last Name:YELLIN
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 1:138 BUCKINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-2307
Mailing Address - Country:US
Mailing Address - Phone:973-744-7093
Mailing Address - Fax:203-764-2416
Practice Address - Street 1:138 BUCKINGHAM RD
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-2307
Practice Address - Country:US
Practice Address - Phone:973-744-7093
Practice Address - Fax:203-764-2416
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08368400207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology