Healthcare Provider Details

I. General information

NPI: 1033185319
Provider Name (Legal Business Name): TRUDY A YAVOREK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 WASHINGTON RD KACH - ATTN CHC
WEST POINT NY
10996-1109
US

IV. Provider business mailing address

21 LAUREL LN
HIGHLAND FALLS NY
10928-1509
US

V. Phone/Fax

Practice location:
  • Phone: 845-938-3003
  • Fax: 845-938-5777
Mailing address:
  • Phone: 845-938-3003
  • Fax: 845-938-5777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD-054439-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: