Healthcare Provider Details

I. General information

NPI: 1750024113
Provider Name (Legal Business Name): AG YES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 COLUMBUS AVE
WEST HARRISON NY
10604-2138
US

IV. Provider business mailing address

338 COLUMBUS AVE
WEST HARRISON NY
10604-2138
US

V. Phone/Fax

Practice location:
  • Phone: 914-949-4296
  • Fax: 914-831-1663
Mailing address:
  • Phone: 914-949-4296
  • Fax: 914-831-1663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name: DR. JINNY GERSTLE
Title or Position: OWNER,DIETITIAN
Credential: EDE,CDN,RDN
Phone: 914-949-4296