Provider Demographics
NPI:1598786246
Name:MERCHANT, YATISH B (MD)
Entity Type:Individual
Prefix:
First Name:YATISH
Middle Name:B
Last Name:MERCHANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 CHRIS GAUPP DR
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4460
Mailing Address - Country:US
Mailing Address - Phone:609-404-9900
Mailing Address - Fax:609-404-3653
Practice Address - Street 1:318 CHRIS GAUPP DR
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4460
Practice Address - Country:US
Practice Address - Phone:609-404-9900
Practice Address - Fax:609-404-3653
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04555600207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP3044447OtherOXFORD
NJ223459862008OtherCIGNA
NJ0232629000OtherAMERIHEALTH
NJ24035OtherAETNA
NJ414527C7NMedicare PIN
NJP3044447OtherOXFORD
NJ223459862008OtherCIGNA
NJ0600395857Medicare PIN