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General NPI Number Information
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NPI Number | 1528651809
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Entity Type | Individual
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Provider Name | DYLAN YURASITS
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Gender | Male
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Dates
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Enumeration Date | 02/17/2021
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Last Update Date | 11/23/2021
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Provider Practice Location Address
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Address Line | 1210 BRACE RD
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City | CHERRY HILL
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State | NJ
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Zip | 08034-3213
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Country | US
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Telephone | 856-536-1515
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Fax |
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Provider Business Mailing Address
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Address Line | 1 FEDERAL ST # 200
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City | CAMDEN
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State | NJ
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Zip | 08103-1088
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Country | US
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Telephone | 856-359-4924
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 25MP00657200
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License Number State | NJ
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