Provider Demographics
NPI:1760483200
Name:YONCLAS, ELAINE M (MD)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:M
Last Name:YONCLAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 WATCHUNG PLZ
Mailing Address - Street 2:SUITE 510
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-4117
Mailing Address - Country:US
Mailing Address - Phone:973-255-1155
Mailing Address - Fax:
Practice Address - Street 1:41 WATCHUNG AVE
Practice Address - Street 2:SUITE 510
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042
Practice Address - Country:US
Practice Address - Phone:973-255-1155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07733100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3K3539OtherHEALTHNET #
NJP00169458OtherRR MDCR #
NJ0152722OtherGHI PPO
NJ2850129000OtherAMERIHEALTH #
NJ2850129000OtherAMERIHEALTH #
NJ0152722OtherGHI PPO