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NPI Code Detail

MEDICARE: MARK A YUSHCHAK PSY.D

MEDICARE: MARK A YUSHCHAK PSY.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologist35S100441800NJ

General Provider Information

NPI Number : 1043487861
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK A YUSHCHAK PSY.D
Provider Business Mailing Address
First Line : 62 E MAIN ST
Second Line :
City : SOMERVILLE
State : NJ
Zip : 08876-2312
Country : US
Telephone Number : 908-725-8880
Fax Number : 908-725-5656
Provider Business Practice Location Address
First Line : 62 E MAIN ST
Second Line :
City : SOMERVILLE
State : NJ
Zip : 08876-2312
Country : US
Telephone Number : 908-725-8880
Fax Number : 908-725-5656
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2008
Last Update Date : 05/12/2008

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