Provider Demographics
NPI:1144337908
Name:YAZGI, NABIL M (MD, PA)
Entity type:Individual
Prefix:DR
First Name:NABIL
Middle Name:M
Last Name:YAZGI
Suffix:
Gender:M
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 HAMBURG TPKE STE 102
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2139
Mailing Address - Country:US
Mailing Address - Phone:973-790-1180
Mailing Address - Fax:973-790-0712
Practice Address - Street 1:401 HAMBURG TPKE STE 102
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2139
Practice Address - Country:US
Practice Address - Phone:973-790-1180
Practice Address - Fax:973-790-0712
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA4538400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3983307Medicaid
NJ3983307Medicaid
NJ520342Medicare ID - Type Unspecified