Healthcare Provider Details

I. General information

NPI: 1427736131
Provider Name (Legal Business Name): YULIYA ZAGORUDKO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2023
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 BERGEN ST
NEWARK NJ
07103-2425
US

IV. Provider business mailing address

18 MARRYOTT ST
MONROE TWP NJ
08831-1654
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-9000
  • Fax:
Mailing address:
  • Phone: 917-587-8648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00777600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: