Healthcare Provider Details

I. General information

NPI: 1275857468
Provider Name (Legal Business Name): YITZHACK ASULIN, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE STE 719
HACKENSACK NJ
07601-1974
US

IV. Provider business mailing address

20 PROSPECT AVE SUITE 719
HACKENSACK NJ
07601-1997
US

V. Phone/Fax

Practice location:
  • Phone: 201-880-5578
  • Fax: 917-543-5638
Mailing address:
  • Phone: 201-880-5578
  • Fax: 917-543-5638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA08686200
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier25MA08686200
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerNJ STATE MEDICAL LICENSE

VIII. Authorized Official

Name: DR. YITZHACK ASULIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 201-880-5578