Healthcare Provider Details

I. General information

NPI: 1114978079
Provider Name (Legal Business Name): SAMUEL YOST MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1561 LONG POND RD STE 133
ROCHESTER NY
14626-4136
US

IV. Provider business mailing address

100 KINGS HWY S
ROCHESTER NY
14617-5504
US

V. Phone/Fax

Practice location:
  • Phone: 585-723-7670
  • Fax: 585-723-7671
Mailing address:
  • Phone: 585-922-3395
  • Fax: 585-922-5114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number302495
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD061848L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number302495
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: