Provider Demographics
NPI:1578863874
Name:KORBMAN, YONATAN A (MS)
Entity Type:Individual
Prefix:MR
First Name:YONATAN
Middle Name:A
Last Name:KORBMAN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 LAFAYETTE AVE
Mailing Address - Street 2:2I
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4782
Mailing Address - Country:US
Mailing Address - Phone:908-208-0814
Mailing Address - Fax:
Practice Address - Street 1:199 LAFAYETTE AVENUE
Practice Address - Street 2:2I
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4782
Practice Address - Country:US
Practice Address - Phone:908-208-0814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ579879174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist