MEDICARE: RUBY YEDLOUTSCHNIG

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	103TC0700X	Clinical Psychologist	35SI00567000	NJ
2	103TC0700X	Clinical Psychologist	022127-1	NY

General Provider Information

NPI Number	:	1245574201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUBY YEDLOUTSCHNIG

Provider Business Mailing Address
First Line	:	67 W BRADFORD AVE
Second Line	:
City	:	CEDAR GROVE
State	:	NJ
Zip	:	07009-1803
Country	:	US
Telephone Number	:	973-830-1057
Fax Number	:	973-604-4259

Provider Business Practice Location Address
First Line	:	67 W BRADFORD AVE
Second Line	:
City	:	CEDAR GROVE
State	:	NJ
Zip	:	07009-1803
Country	:	US
Telephone Number	:	973-830-1057
Fax Number	:	973-604-4259

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

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	03/19/2026

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