Healthcare Provider Details

I. General information

NPI: 1427111632
Provider Name (Legal Business Name): CAROLINE PENFIELD YAVETZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 02/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 BRIDGE ST
PLATTSBURGH NY
12901
US

IV. Provider business mailing address

1623 THIRD AVE 4GW
NEW YORK NY
10128
US

V. Phone/Fax

Practice location:
  • Phone: 518-561-7337
  • Fax: 518-561-1335
Mailing address:
  • Phone: 212-860-1003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number164377
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: