Provider Demographics
NPI:1962623868
Name:UYCHICH, PRISCILLA MARY (DO)
Entity type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:MARY
Last Name:UYCHICH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:290 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-2014
Mailing Address - Country:US
Mailing Address - Phone:201-796-0866
Mailing Address - Fax:201-475-1554
Practice Address - Street 1:290 MARKET ST
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407-2014
Practice Address - Country:US
Practice Address - Phone:201-796-0866
Practice Address - Fax:201-475-1554
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB66820207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJUY004217Medicare UPIN