Provider Demographics
NPI:1609947340
Name:BAKSHIYEV, YULIYA (MD)
Entity Type:Individual
Prefix:DR
First Name:YULIYA
Middle Name:
Last Name:BAKSHIYEV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JULIA
Other - Middle Name:
Other - Last Name:BAKSHIYEV
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:41 JOSEPH ST
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8332
Mailing Address - Country:US
Mailing Address - Phone:732-863-1157
Mailing Address - Fax:
Practice Address - Street 1:25 KILMER DR
Practice Address - Street 2:STE 217
Practice Address - City:MORGANVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07751-1564
Practice Address - Country:US
Practice Address - Phone:732-617-8888
Practice Address - Fax:732-617-8880
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA64214208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6969208Medicaid
NJG30428Medicare UPIN
NJ6969208Medicaid