Healthcare Provider Details

I. General information

NPI: 1477657252
Provider Name (Legal Business Name): RAMIRO D. YEPEZ D.P.M., LLC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 11/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 CONGRESS ST
NEWARK NJ
07105-1802
US

IV. Provider business mailing address

69 THOMAS DR
CLARK NJ
07066-2224
US

V. Phone/Fax

Practice location:
  • Phone: 973-344-4415
  • Fax: 973-344-5224
Mailing address:
  • Phone: 732-771-7580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00283400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: