Healthcare Provider Details

I. General information

NPI: 1821297615
Provider Name (Legal Business Name): AYLA YAVIN MS LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 W 29TH ST RM 1103
NEW YORK NY
10001-5224
US

IV. Provider business mailing address

135 W 29TH ST RM 1103
NEW YORK NY
10001-5224
US

V. Phone/Fax

Practice location:
  • Phone: 917-331-2694
  • Fax: 718-852-4586
Mailing address:
  • Phone: 917-331-2694
  • Fax: 718-852-4586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25003580
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: