Provider Demographics
NPI:1689768079
Name:YATSKOWITZ, JEROME P (MD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:P
Last Name:YATSKOWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 26666
Mailing Address - Street 2:PHS PROVIDER ENROLLMENT
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:505-923-5356
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:201 CEDAR ST SE STE 7600
Practice Address - Street 2:PRESBYTERIAN HEART GROUP (PHG)
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4921
Practice Address - Country:US
Practice Address - Phone:505-563-2500
Practice Address - Fax:505-563-2599
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM92380207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000E5897Medicaid
NMNM301112Medicare PIN
NM000E5897Medicaid
F35612Medicare UPIN
NM$$$$$$$$$WMedicare PIN
NMNM301137Medicare PIN
$$$$$$$$$PMedicare PIN