Provider Demographics
NPI:1932122272
Name:YEPEZ, HUMBERTO RAFAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:HUMBERTO
Middle Name:RAFAEL
Last Name:YEPEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-1802
Mailing Address - Country:US
Mailing Address - Phone:973-344-4772
Mailing Address - Fax:
Practice Address - Street 1:88 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-1802
Practice Address - Country:US
Practice Address - Phone:973-344-4772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03160700208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0788406Medicaid
NJ0788406Medicaid
446767Medicare ID - Type Unspecified