Healthcare Provider Details

I. General information

NPI: 1063752004
Provider Name (Legal Business Name): YOLAINE ST.LOUIS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 UNIONDALE AVE
UNIONDALE NY
11553-3235
US

IV. Provider business mailing address

905 UNIONDALE AVE
UNIONDALE NY
11553-3235
US

V. Phone/Fax

Practice location:
  • Phone: 516-485-4630
  • Fax: 516-489-3682
Mailing address:
  • Phone: 516-485-4630
  • Fax: 516-489-3682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number155165
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number155165
License Number StateNY

VIII. Authorized Official

Name: DR. YOLAINE ST.LOUIS
Title or Position: PRESIDENT
Credential: MD
Phone: 516-485-4630