Provider Demographics
NPI:1376598136
Name:BIRGER, YELENA (MD)
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:BIRGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WALDEN CT
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3573
Mailing Address - Country:US
Mailing Address - Phone:732-360-0619
Mailing Address - Fax:732-333-0004
Practice Address - Street 1:300 CRAIG RD
Practice Address - Street 2:SUITE 208
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8742
Practice Address - Country:US
Practice Address - Phone:732-333-0062
Practice Address - Fax:732-333-0004
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226826207RA0000X
NJ25MB07663700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02389839Medicaid
NJ097612Medicare PIN
NYH90711Medicare UPIN
NY02389839Medicaid