Healthcare Provider Details

I. General information

NPI: 1841515376
Provider Name (Legal Business Name): DR. YANIV LARISH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2010
Last Update Date: 09/07/2024
Certification Date: 09/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177A E MAIN ST # 374
NEW ROCHELLE NY
10801-5711
US

IV. Provider business mailing address

177A E MAIN ST # 374
NEW ROCHELLE NY
10801-5711
US

V. Phone/Fax

Practice location:
  • Phone: 212-370-4170
  • Fax:
Mailing address:
  • Phone: 212-370-4170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number281709
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number281709
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: