Provider Demographics
NPI:1467691709
Name:BURDEN, YUMIE NISHIDA (DO)
Entity Type:Individual
Prefix:
First Name:YUMIE
Middle Name:NISHIDA
Last Name:BURDEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:YUMIE
Other - Middle Name:
Other - Last Name:NISHIDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:88 W RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3199
Mailing Address - Country:US
Mailing Address - Phone:201-345-0772
Mailing Address - Fax:
Practice Address - Street 1:88 W RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3199
Practice Address - Country:US
Practice Address - Phone:201-345-0772
Practice Address - Fax:877-991-5730
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2018-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09495700207Q00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2021633Medicaid
WA2021633Medicaid