Healthcare Provider Details

I. General information

NPI: 1801184056
Provider Name (Legal Business Name): ALAN C. YANCOVITCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2011
Last Update Date: 05/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E 233RD ST
BRONX NY
10466-2604
US

IV. Provider business mailing address

600 E 233RD ST 7TH FLOOR - DEPARTMENT OF PSYCHIATRY
BRONX NY
10466-2604
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-9535
  • Fax: 718-920-9217
Mailing address:
  • Phone: 718-920-9535
  • Fax: 718-920-9217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number276809
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: