Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | 25MA077337000 | NJ |
Y | 208200000X | Surgeon | 25MA07733700 | NJ |
Y | 208600000X | Surgeon | 25MA07733700 | NJ |
NPI | 1053330647 |
---|---|
Provider Name | Jonathan P Yrad |
First Address | Brick, NJ 08723-6077 |
Second Address | Brick, NJ 08723-6077 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 22/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0043842 | (05) | NJ |
I15579 | (02) | NJ |