Healthcare Provider Details

I. General information

NPI: 1164971370
Provider Name (Legal Business Name): HALYNA YURCHAK NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 LAUREL HEIGHTS DR
BRIDGETON NJ
08302-3635
US

IV. Provider business mailing address

786 FOXMOOR DR
VINELAND NJ
08361-7254
US

V. Phone/Fax

Practice location:
  • Phone: 856-455-4800
  • Fax: 856-541-0650
Mailing address:
  • Phone: 856-340-0026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ0063500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: