Healthcare Provider Details

I. General information

NPI: 1194088948
Provider Name (Legal Business Name): YURIY SHEPELYAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 MADISON AVE FL 6
NEW YORK NY
10022-5403
US

IV. Provider business mailing address

515 MADISON AVE FL 6
NEW YORK NY
10022-5403
US

V. Phone/Fax

Practice location:
  • Phone: 212-752-6770
  • Fax:
Mailing address:
  • Phone: 212-752-6770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number288641
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD457901
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: