MEDICARE: DR. YEHUDA ISSEROFF DDS

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	122300000X	Dentist	22DI026544000	NJ

General Provider Information

NPI Number	:	1487152377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YEHUDA ISSEROFF DDS

Provider Business Mailing Address
First Line	:	57 GLENWOOD DR E
Second Line	:
City	:	BERGENFIELD
State	:	NJ
Zip	:	07621-3341
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	625 LAFAYETTE AVE
Second Line	:
City	:	HAWTHORNE
State	:	NJ
Zip	:	07506-3401
Country	:	US
Telephone Number	:	973-567-7773
Fax Number	:

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

Provider Enumeration Date	:	01/25/2018
Last Update Date	:	01/25/2018

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