MEDICARE: DR. SANDRA RUTH YAROCK PSYD

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	103T00000X	Psychologist	35S100232800	NJ

General Provider Information

NPI Number	:	1568503092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA RUTH YAROCK PSYD

Provider Business Mailing Address
First Line	:	38 MURANO DR
Second Line	:
City	:	PRINCETON JUNCTION
State	:	NJ
Zip	:	08550-2468
Country	:	US
Telephone Number	:	609-799-8078
Fax Number	:	609-799-1101

Provider Business Practice Location Address
First Line	:	38 MURANO DR
Second Line	:
City	:	PRINCETON JUNCTION
State	:	NJ
Zip	:	08550-2468
Country	:	US
Telephone Number	:	609-275-6617
Fax Number	:	609-799-1101

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

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	10/25/2012

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