Healthcare Provider Details

I. General information

NPI: 1932122272
Provider Name (Legal Business Name): HUMBERTO RAFAEL YEPEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 CONGRESS ST
NEWARK NJ
07105-1802
US

IV. Provider business mailing address

88 CONGRESS ST
NEWARK NJ
07105-1802
US

V. Phone/Fax

Practice location:
  • Phone: 973-344-4772
  • Fax:
Mailing address:
  • Phone: 973-344-4772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA03160700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: