Healthcare Provider Details

I. General information

NPI: 1902922586
Provider Name (Legal Business Name): JENNY YEE-LEVIN RPAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 11TH AVE
NEW YORK NY
10019-3535
US

IV. Provider business mailing address

450 EAST 63RD STREET, 11C
NEW YORK NY
10021
US

V. Phone/Fax

Practice location:
  • Phone: 212-369-5566
  • Fax: 929-992-9303
Mailing address:
  • Phone: 646-373-7412
  • Fax: 212-583-1141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number008584-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: