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General NPI Number Information
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NPI Number | 1578863874
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Entity Type | Individual
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Provider Name | YONATAN A KORBMAN M.S.
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Gender | Male
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Dates
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Enumeration Date | 11/02/2010
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Last Update Date | 11/02/2010
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Provider Practice Location Address
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Address Line | 199 LAFAYETTE AVENUE 2I
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City | PASSAIC
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State | NJ
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Zip | 07055-4782
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Country | US
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Telephone | 908-208-0814
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Fax |
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Provider Business Mailing Address
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Address Line | 199 LAFAYETTE AVE 2I
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City | PASSAIC
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State | NJ
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Zip | 07055-4782
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Country | US
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Telephone | 908-208-0814
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 579879
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License Number State | NJ
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