Provider Demographics
NPI:1063999605
Name:PRAG, YOCHEVED FAY (APN)
Entity type:Individual
Prefix:
First Name:YOCHEVED
Middle Name:FAY
Last Name:PRAG
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:FAY
Other - Middle Name:
Other - Last Name:PRAG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN
Mailing Address - Street 1:456 CHESTNUT ST STE 201
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-6124
Mailing Address - Country:US
Mailing Address - Phone:732-905-9200
Mailing Address - Fax:732-905-4470
Practice Address - Street 1:456 CHESTNUT ST STE 201
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-6124
Practice Address - Country:US
Practice Address - Phone:732-905-9200
Practice Address - Fax:732-905-4470
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00817300363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner