Provider Demographics
NPI:1033476569
Name:NAGAHAMA, YASUNORI (MD)
Entity type:Individual
Prefix:DR
First Name:YASUNORI
Middle Name:
Last Name:NAGAHAMA
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 1:379 CAMPUS DR FL 4
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1161
Mailing Address - Country:US
Mailing Address - Phone:732-937-8939
Mailing Address - Fax:
Practice Address - Street 1:379 CAMPUS DR FL 4
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1161
Practice Address - Country:US
Practice Address - Phone:732-937-8939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-22
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0063720207T00000X
IAMD-45124207T00000X
NJ25MA11101500207T00000X
IAR-9419207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ791563Medicaid