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General NPI Number Information
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NPI Number | 1851444228
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Entity Type | Individual
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Provider Name | YANTO MEIYER GULTOM MD
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Gender | Male
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 09/22/2014
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Provider Practice Location Address
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Address Line | 403 TOWNE CENTRE DR
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City | HILLSBOROUGH
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State | NJ
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Zip | 08844-4698
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Country | US
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Telephone | 908-428-4840
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Fax | 908-382-3288
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Provider Business Mailing Address
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Address Line | 75 WILLOCKS CIR
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City | SOMERSET
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State | NJ
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Zip | 08873-7462
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Country | US
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Telephone | 732-322-5223
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Fax | 908-382-3288
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MA07450700
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License Number State | NJ
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