Healthcare Provider Details

I. General information

NPI: 1558965814
Provider Name (Legal Business Name): YULIYA SHRAYMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2020
Last Update Date: 11/27/2020
Certification Date: 11/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 W PLEASANTVIEW AVE
HACKENSACK NJ
07601-8005
US

IV. Provider business mailing address

380 W PLEASANTVIEW AVE
HACKENSACK NJ
07601-8005
US

V. Phone/Fax

Practice location:
  • Phone: 201-342-0847
  • Fax: 844-224-0650
Mailing address:
  • Phone: 201-342-0847
  • Fax: 844-224-0650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02632700
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: