Provider Demographics
NPI:1104876499
Name:RAKLA, YOUNUS A (MD)
Entity type:Individual
Prefix:DR
First Name:YOUNUS
Middle Name:A
Last Name:RAKLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 OAK TREE AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5136
Mailing Address - Country:US
Mailing Address - Phone:908-756-1703
Mailing Address - Fax:908-756-1793
Practice Address - Street 1:902 OAK TREE AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5136
Practice Address - Country:US
Practice Address - Phone:908-756-1703
Practice Address - Fax:908-756-1793
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3297269Medicaid
NJ3297269Medicaid
NJ053915Medicare ID - Type Unspecified