Healthcare Provider Details

I. General information

NPI: 1871540732
Provider Name (Legal Business Name): YURIJ TRYTJAK O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 RYDERS LANE
MILLTOWN NJ
08850-1353
US

IV. Provider business mailing address

PO BOX 2579
PLAINFIELD NJ
07060-0579
US

V. Phone/Fax

Practice location:
  • Phone: 732-937-4700
  • Fax:
Mailing address:
  • Phone: 732-937-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00357400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: