1093009755 NPI number — NYULMC

Table of content: YANA SARA SHEVKHOD LMFT (NPI 1437612769)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093009755 NPI number — NYULMC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NYULMC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1093009755
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 EVELYN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SYOSSET
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11791-5806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-921-1701
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
560 1ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10016-6402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-263-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/30/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DUBROW
Authorized Official First Name:
LISA
Authorized Official Middle Name:
BETH
Authorized Official Title or Position:
NP
Authorized Official Telephone Number:
212-263-5590

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  304020 , 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)