Provider Demographics
NPI:1376643817
Name:YUDKOFF, NEAL STEPHEN (DPM)
Entity type:Individual
Prefix:DR
First Name:NEAL
Middle Name:STEPHEN
Last Name:YUDKOFF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-4044
Mailing Address - Country:US
Mailing Address - Phone:973-783-5101
Mailing Address - Fax:973-783-2821
Practice Address - Street 1:119 GROVE ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4044
Practice Address - Country:US
Practice Address - Phone:973-783-5101
Practice Address - Fax:973-783-2821
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD01131213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ461178Medicare PIN
NJT73006Medicare UPIN