Provider Demographics
NPI:1770309718
Name:HERASME, YOKASTA
Entity type:Individual
Prefix:MS
First Name:YOKASTA
Middle Name:
Last Name:HERASME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-1331
Mailing Address - Country:US
Mailing Address - Phone:917-334-3867
Mailing Address - Fax:
Practice Address - Street 1:465 LAKE ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-1331
Practice Address - Country:US
Practice Address - Phone:917-334-3867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJR60017907952821172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver