Provider Demographics
NPI:1871540732
Name:TRYTJAK, YURIJ (OD)
Entity type:Individual
Prefix:DR
First Name:YURIJ
Middle Name:
Last Name:TRYTJAK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2579
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-0579
Mailing Address - Country:US
Mailing Address - Phone:732-937-4700
Mailing Address - Fax:
Practice Address - Street 1:232 RYDERS LANE
Practice Address - Street 2:
Practice Address - City:MILLTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08850-1353
Practice Address - Country:US
Practice Address - Phone:732-937-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00357400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ09952OtherDAVIS VISION
NJ9620OtherAMERICHOICE
NJXXXXXXOtherAMERIGROUP
NJ0224705000OtherAMERIHEALTH
NJ3631010Medicaid
NJTT15964OtherSPECTERA
1K6048OtherHEALTHNET
0457754OtherAETNA - USH
0580000001OtherTRAVELER'S DMERC
NJC67061OtherWELLCHOICE
NJ0224705000OtherAMERIHEALTH
NJTR521299Medicare ID - Type Unspecified