Healthcare Provider Details

I. General information

NPI: 1720072036
Provider Name (Legal Business Name): EDWARD JOHN YATCO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 07/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRADHURST AVE SUITE 1700
HAWTHORNE NY
10532-2140
US

IV. Provider business mailing address

22 SAW MILL RIVER RD
HAWTHORNE NY
10532-1533
US

V. Phone/Fax

Practice location:
  • Phone: 914-347-0162
  • Fax: 914-347-4401
Mailing address:
  • Phone: 914-593-1606
  • Fax: 914-593-1790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number226637
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: