1114094166 NPI number — MS. ALIZA YANOVSKY PHD

Table of content: MS. ALIZA YANOVSKY PHD (NPI 1114094166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114094166 NPI number — MS. ALIZA YANOVSKY PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YANOVSKY
Provider First Name:
ALIZA
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PHD
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:
1114094166
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19 WEST 34 STREET
Provider Second Line Business Mailing Address:
PENTHOUSE
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-947-7111
Provider Business Mailing Address Fax Number:
212-239-0948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19 WEST 34 STREET
Provider Second Line Business Practice Location Address:
PENTHOUSE
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-947-7111
Provider Business Practice Location Address Fax Number:
212-239-0948
Provider Enumeration Date:
11/28/2006

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: 103TC0700X , with the licence number:  013109 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 103TF0200X , with the licence number: 013109 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 02243718 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P2594121 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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