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Individual

AL-LATEEF YANCEY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
508 S ORANGE AVE, NEWARK, NJ 07103-1338
(973) 277-6417
Mailing address
508 S ORANGE AVE, NEWARK, NJ 07103-1338
(973) 277-6417

Taxonomy

Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
32WD02927600
NJ
335E00000X
Prosthetic/Orthotic Supplier
Primary
32WD02927600
NJ

Other

Enumeration date
09/21/2022
Last updated
09/21/2022
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