Healthcare Provider Details

I. General information

NPI: 1346695335
Provider Name (Legal Business Name): RAPHAEL YEUNG DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 05/30/2023
Certification Date: 05/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 ROUTE 28 STE 2109
RARITAN NJ
08869-1354
US

IV. Provider business mailing address

575 ROUTE 28 STE 2109
RARITAN NJ
08869-1354
US

V. Phone/Fax

Practice location:
  • Phone: 908-588-2880
  • Fax:
Mailing address:
  • Phone: 908-588-2880
  • Fax: 908-332-5739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00348900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: