Provider Demographics
NPI:1780653956
Name:YOSLOV, MICHAEL (DO, FACOI)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:YOSLOV
Suffix:
Gender:M
Credentials:DO, FACOI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1206 W. SHERMAN AVENUE
Mailing Address - Street 2:BUILDING #3, SUITE A
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360
Mailing Address - Country:US
Mailing Address - Phone:856-692-0673
Mailing Address - Fax:856-692-1460
Practice Address - Street 1:1206 W. SHERMAN AVENUE
Practice Address - Street 2:BUILDING #3, SUITE A
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360
Practice Address - Country:US
Practice Address - Phone:856-692-0673
Practice Address - Fax:856-692-1460
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07127400207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1050686OtherHORIZON MERCY
1K7727OtherHEALTH NET
1136926OtherFIRST HEALTH
985657OtherKEYSTONE
2500177OtherAETNA HMO
NJ8296707Medicaid
922296OtherAMERIHEALTH PPO
1551342OtherAARP
5325482OtherAETNA PPO
223586136OtherATLANTICARE
880224211OtherPALMETTO
1000309500OtherAMERICHOICE
0863643000OtherAMERIHEALTH HMO
G44888Medicare UPIN
1551342OtherAARP