Healthcare Provider Details

I. General information

NPI: 1518278563
Provider Name (Legal Business Name): NAOMI YACHELEVICH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2010
Last Update Date: 05/10/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 W 86TH ST
NEW YORK NY
10024-3671
US

IV. Provider business mailing address

3595 BROADWAY
NEW YORK NY
10031-3218
US

V. Phone/Fax

Practice location:
  • Phone: 212-304-5800
  • Fax:
Mailing address:
  • Phone: 212-305-6731
  • Fax: 212-305-9058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number261583-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: