Provider Demographics
NPI:1467690602
Name:RAMIRO D YEPEZ DPM
Entity Type:Organization
Organization Name:RAMIRO D YEPEZ DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRY
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMIRO
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:YEPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:973-344-4415
Mailing Address - Street 1:88 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-1802
Mailing Address - Country:US
Mailing Address - Phone:973-344-4415
Mailing Address - Fax:973-344-5224
Practice Address - Street 1:88 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-1802
Practice Address - Country:US
Practice Address - Phone:973-344-4415
Practice Address - Fax:973-344-5224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00283400213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5641780001Medicare NSC
NJ093425Medicare PIN