1124706197 NPI number — MISS YVONNE B LLEWELLYN HOME HEALTH AIDE

Table of content: MISS YVONNE B LLEWELLYN HOME HEALTH AIDE (NPI 1124706197)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124706197 NPI number — MISS YVONNE B LLEWELLYN HOME HEALTH AIDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LLEWELLYN
Provider First Name:
YVONNE
Provider Middle Name:
B
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
HOME HEALTH AIDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GASALBERTI
Provider Other First Name:
RICHARD
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
HOME HEALTH AIDE
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1124706197
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17406 110TH AVE # 1A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JAMAICA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11433-3456
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-399-4572
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7136 110TH ST APT 1L
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOREST HILLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11375-4860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-544-7700
Provider Business Practice Location Address Fax Number:
718-793-2942
Provider Enumeration Date:
07/10/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 374U00000X , with the licence number:  01171244 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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