Provider Demographics
NPI:1275857468
Name:YITZHACK ASULIN, MD, PC
Entity Type:Organization
Organization Name:YITZHACK ASULIN, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YITZHACK
Authorized Official - Middle Name:
Authorized Official - Last Name:ASULIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-880-5578
Mailing Address - Street 1:20 PROSPECT AVE
Mailing Address - Street 2:SUITE 719
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1997
Mailing Address - Country:US
Mailing Address - Phone:201-880-5578
Mailing Address - Fax:917-543-5638
Practice Address - Street 1:20 PROSPECT AVE STE 719
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1974
Practice Address - Country:US
Practice Address - Phone:201-880-5578
Practice Address - Fax:917-543-5638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08686200174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA08686200OtherNJ STATE MEDICAL LICENSE