Healthcare Provider Details

I. General information

NPI: 1295094670
Provider Name (Legal Business Name): AARON EDWARD YANCOSKIE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2012
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 57TH ST SUITE 810
NEW YORK NY
10019-3211
US

IV. Provider business mailing address

200 W 57TH ST SUITE 810
NEW YORK NY
10019-3211
US

V. Phone/Fax

Practice location:
  • Phone: 917-797-1601
  • Fax:
Mailing address:
  • Phone: 917-797-1601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number058235
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: