Healthcare Provider Details

I. General information

NPI: 1386703338
Provider Name (Legal Business Name): MICHELLE ROBIN YAGODA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 E 83RD ST
NEW YORK NY
10028-0401
US

IV. Provider business mailing address

5 E 83RD ST
NEW YORK NY
10028-0401
US

V. Phone/Fax

Practice location:
  • Phone: 212-434-1210
  • Fax: 212-535-8155
Mailing address:
  • Phone: 212-434-1210
  • Fax: 212-535-8155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number182512
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: