Healthcare Provider Details

I. General information

NPI: 1568083475
Provider Name (Legal Business Name): JOHN MICHAEL YAVORSKI III DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2020
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 ROE AVE
ELMIRA NY
14905-1676
US

IV. Provider business mailing address

600 IVY ST STE 206
ELMIRA NY
14905-1627
US

V. Phone/Fax

Practice location:
  • Phone: 607-737-7770
  • Fax: 607-271-3686
Mailing address:
  • Phone: 607-271-2050
  • Fax: 607-271-2071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number325753
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number325753
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: