Provider Demographics
NPI:1578638136
Name:DUCHEINE, YVAN (MD)
Entity type:Individual
Prefix:DR
First Name:YVAN
Middle Name:
Last Name:DUCHEINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07203-2056
Mailing Address - Country:US
Mailing Address - Phone:973-735-3422
Mailing Address - Fax:
Practice Address - Street 1:125 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:NJ
Practice Address - Zip Code:07203-2056
Practice Address - Country:US
Practice Address - Phone:973-674-4042
Practice Address - Fax:973-674-5070
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA06289400208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7188005Medicaid
NJDU953156Medicare ID - Type Unspecified
NJG17575Medicare UPIN