MEDICARE: LONNA YEGEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	25MA03008000	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184625501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LONNA YEGEN MD

Provider Business Mailing Address
First Line	:	500 PIERMONT RD
Second Line	:
City	:	CLOSTER
State	:	NJ
Zip	:	07624-2845
Country	:	US
Telephone Number	:	201-784-3200
Fax Number	:	201-984-3312

Provider Business Practice Location Address
First Line	:	500 PIERMONT RD
Second Line	:
City	:	CLOSTER
State	:	NJ
Zip	:	07624-2845
Country	:	US
Telephone Number	:	201-784-3200
Fax Number	:	201-984-3312

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	01/18/2013

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