Provider Demographics
NPI:1720371149
Name:NABIL M YAZGI, M.D. P.A.
Entity Type:Organization
Organization Name:NABIL M YAZGI, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:M
Authorized Official - Last Name:YAZGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-790-1180
Mailing Address - Street 1:401 HAMBURG TPKE STE 102
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2139
Mailing Address - Country:US
Mailing Address - Phone:973-790-1180
Mailing Address - Fax:973-790-0712
Practice Address - Street 1:401 HAMBURG TURNPIKE, SUITE 102
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2139
Practice Address - Country:US
Practice Address - Phone:973-790-1180
Practice Address - Fax:973-790-0712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA4538400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3983307Medicaid
NJC56679Medicare UPIN