| Rdt | |
|
440 West St Ste 318 Fort Lee NJ 07024-5028 | |
| (646) 685-9836 | |
| (888) 512-2123 |
| Full Name | Rdt |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 440 West St Ste 318, Fort Lee, New Jersey |
| Authorized Official Name and Position | Yuli Fradkin (MD) |
| Authorized Official Contact | 6466859836 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rdt 39 James St Montclair NJ 07042-2913 Ph: (646) 685-9836 | Rdt 440 West St Ste 318 Fort Lee NJ 07024-5028 Ph: (646) 685-9836 |
| NPI Number | 1619555620 |
|---|---|
| Provider Enumeration Date | 03/31/2021 |
| Last Update Date | 12/18/2023 |
| Certification Date | 12/18/2023 |
| Medicare PECOS PAC ID | 6204245020 |
|---|---|
| Medicare Enrollment ID | O20210507001155 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619555620 | NPI | - | NPPES |
| 1255589461 | Other | NJ | NPI-1 |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | (* (Not Available)) | Secondary |
| Provider Name | Yuli Fradkin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255589461 PECOS PAC ID: 5496936924 Enrollment ID: I20140924000085 |
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