Yvan Ducheine, M.D.
Individual provider Active NPI Surgery Physician · Roselle, NJ
NPI 1578638136 · NPPES record last updated Jan 28, 2021
Key facts
- NPI
- 1578638136
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- MA06289400 (NJ)
- Practice address
- 125 W 4TH Ave
Roselle, NJ 07203-2056 - Phone
- (973) 674-4042
- Fax
- (973) 674-5070
- NPI assigned
- Nov 21, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA06289400 | NJ | MD | Surgery Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | MA06289400 | NJ | Yes |
Addresses
Primary practice location
125 W 4TH Ave
Roselle, NJ 07203-2056
Mailing address
125 W 4TH Ave
Roselle, NJ 07203-2056
Phone (973) 735-3422
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7188005 | Medicaid | NJ |
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- E Gerald Coopersmith DMD
- Ellioth Fishkin MD LLC
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- Enchanted Impressions
- Ethical Mobile Dna
All providers in Roselle, NJ · Surgery Physician in New Jersey
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 28, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.