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General NPI Number Information
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NPI Number | 1972908960
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Entity Type | Organization
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Legal Business Name | YULI FRADKIN MD LLC
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Dates
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Enumeration Date | 11/03/2014
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Last Update Date | 03/25/2023
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Provider Practice Location Address
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Address Line | 94 VALLEY RD FL 2
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2211
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Country | US
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Telephone | 646-685-9836
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Fax | 888-512-2123
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Provider Business Mailing Address
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Address Line | 39 JAMES ST
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2913
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Country | US
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Telephone | 646-685-9836
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. YULI FRADKIN
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Credential |
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Telephone | 646-685-9836
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 25MA09283000
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License Number State | NJ
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