Provider Demographics
NPI:1598822942
Name:YEROVI, LUIS A JR (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:A
Last Name:YEROVI
Suffix:JR
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 1:125 GARDEN ST
Mailing Address - Street 2:APT 4B
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-8102
Mailing Address - Country:US
Mailing Address - Phone:201-420-7992
Mailing Address - Fax:
Practice Address - Street 1:91 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-1801
Practice Address - Country:US
Practice Address - Phone:973-344-7676
Practice Address - Fax:973-690-5109
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05714900207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ64901-07Medicaid
NJG60828Medicare UPIN
NJ64901-07Medicaid