Healthcare Provider Details

I. General information

NPI: 1487369047
Provider Name (Legal Business Name): ALLISON LOU YAVARI DMSC, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 E 39TH ST
NEW YORK NY
10016-0968
US

IV. Provider business mailing address

113 E 39TH ST
NEW YORK NY
10016-0968
US

V. Phone/Fax

Practice location:
  • Phone: 212-223-0716
  • Fax:
Mailing address:
  • Phone: 919-928-4172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberC0009306
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00842100
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9117092
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number031590
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: