Healthcare Provider Details

I. General information

NPI: 1760104947
Provider Name (Legal Business Name): ALISON L YEZARSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 ALINDA AVE
WEST ISLIP NY
11795-2325
US

IV. Provider business mailing address

43 ALINDA AVE
WEST ISLIP NY
11795-2325
US

V. Phone/Fax

Practice location:
  • Phone: 631-702-5359
  • Fax:
Mailing address:
  • Phone: 631-702-5359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number344263
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: