MEDICARE: NICHOLAS D. YATRAKIS M.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
1	207R00000X	Internal Medicine Physician	MA32184	NJ

General Provider Information

NPI Number	:	1316993876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS D. YATRAKIS M.D.

Provider Business Mailing Address
First Line	:	1 DIAMOND HILL RD
Second Line	:	SUMMIT MEDICAL GROUP
City	:	BERKELEY HEIGHTS
State	:	NJ
Zip	:	07922-2104
Country	:	US
Telephone Number	:	908-273-4300
Fax Number	:	908-228-3617

Provider Business Practice Location Address
First Line	:	560 SPRINGFIELD AVE
Second Line	:
City	:	WESTFIELD
State	:	NJ
Zip	:	07090-1024
Country	:	US
Telephone Number	:	908-228-3610
Fax Number	:	908-228-3617

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	07/10/2019

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