Provider Demographics
NPI:1316993876
Name:YATRAKIS, NICHOLAS D (MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:D
Last Name:YATRAKIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 DIAMOND HILL RD
Mailing Address - Street 2:SUMMIT MEDICAL GROUP
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-2104
Mailing Address - Country:US
Mailing Address - Phone:908-273-4300
Mailing Address - Fax:908-228-3617
Practice Address - Street 1:560 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-1024
Practice Address - Country:US
Practice Address - Phone:908-228-3610
Practice Address - Fax:908-228-3617
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA32184207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF07043Medicare UPIN
NJ185720BSDMedicare ID - Type Unspecified