Healthcare Provider Details

I. General information

NPI: 1831155498
Provider Name (Legal Business Name): MICHAEL JAY YELLEN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2006
Last Update Date: 02/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 BROADWAY
HILLSDALE NJ
07642-2054
US

IV. Provider business mailing address

185 BROADWAY PO BOX 487
HILLSDALE NJ
07642-2054
US

V. Phone/Fax

Practice location:
  • Phone: 201-666-0230
  • Fax: 201-722-1111
Mailing address:
  • Phone: 201-666-0230
  • Fax: 201-722-1111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number002978
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: