Healthcare Provider Details

I. General information

NPI: 1083175897
Provider Name (Legal Business Name): YONATAN BARDASH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: YONI BARDASH MD

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE
HACKENSACK NJ
07601-1915
US

IV. Provider business mailing address

786 WASHBURN ST
TEANECK NJ
07666-2243
US

V. Phone/Fax

Practice location:
  • Phone: 551-996-2000
  • Fax:
Mailing address:
  • Phone: 201-575-6710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA11748400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: