Provider Demographics
NPI:1174524045
Name:AYDIN, EMMANUEL AYTURK (MD)
Entity type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:AYTURK
Last Name:AYDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:AYTURK
Other - Middle Name:EMMANUEL
Other - Last Name:AYDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:508 HAMBURG TPKE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470
Mailing Address - Country:US
Mailing Address - Phone:973-595-0096
Mailing Address - Fax:973-595-6414
Practice Address - Street 1:508 HAMBURG TPKE
Practice Address - Street 2:SUITE 102
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470
Practice Address - Country:US
Practice Address - Phone:973-595-0096
Practice Address - Fax:973-595-6414
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2008-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06743400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7615604Medicaid
NJ7615604Medicaid
NJ012116NEMMedicare PIN
NJG74783Medicare UPIN