Individual
YURIY OLEGOVICH IVANOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
125 PATERSON ST, NEW BRUNSWICK, NJ 08901-1962
(732) 235-7661
(732) 235-7246
Mailing address
1554 NORTHERN BLVD FL 4, MANHASSET, NY 11030-3053
(516) 321-6410
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
276396
NY
208VP0000X
Pain Medicine Physician
Primary
1790026011
NJ
Other
Enumeration date
03/12/2013
Last updated
01/10/2025
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