Healthcare Provider Details

I. General information

NPI: 1174955744
Provider Name (Legal Business Name): VICTOR B YABIDI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 08/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 WEEQUAHIC AVE
NEWARK NJ
07112-1730
US

IV. Provider business mailing address

224 WEEQUAHIC AVE
NEWARK NJ
07112-1730
US

V. Phone/Fax

Practice location:
  • Phone: 973-592-6899
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00458700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: