Provider Demographics
NPI:1679673636
Name:DUCK, EVANDER JR (MD,MS)
Entity Type:Individual
Prefix:DR
First Name:EVANDER
Middle Name:
Last Name:DUCK
Suffix:JR
Gender:M
Credentials:MD,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SHIRA LN
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:495 IRON BRIDGE RD
Practice Address - Street 2:SUITE 7
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-3069
Practice Address - Country:US
Practice Address - Phone:732-780-8477
Practice Address - Fax:732-780-2979
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA060290174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG27901Medicare UPIN
NJ866035Medicare PIN