1689656472 NPI number — YENA H DO DPM

Table of content: YENA H DO DPM (NPI 1689656472)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689656472 NPI number — YENA H DO DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DO
Provider First Name:
YENA
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689656472
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2211 MASSACHUSETTS AVE
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
CAMBRIDGE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02140-1211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-821-6329
Provider Business Mailing Address Fax Number:
617-354-3877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2211 MASSACHUSETTS AVE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02140-1211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-821-6329
Provider Business Practice Location Address Fax Number:
617-354-3877
Provider Enumeration Date:
11/17/2005

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: 213ES0103X , with the licence number:  2217 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0385140 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 70142 . This is a "HEALTHY START" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA69029 . This is a "HARVARD PILGRIM HEALTHCAR" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0385140 . This is a "MEDICAID WELFARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1368003 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1689656472 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7022085 . This is a "CIGNA HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 95995101 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 205191632 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 205191632 . This is a "COMMONWEALTH INDEMNITY" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 44137 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y71115 . This is a "BLUE SHIELD HMO BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: Y71115 . This is a "BLUE SHIELD INDEMNITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 70142 . This is a "CHILDRENS MEDICAL SECURIT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 90539 . This is a "FALLON COMMUNITY HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 205191632 . This is a "GREATWEST HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y75147 . This is a "MEDICARE B" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com