Healthcare Provider Details

I. General information

NPI: 1659013886
Provider Name (Legal Business Name): PERRY K YAZZOLINO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 BEACH RD STE A
WESTHAMPTON BEACH NY
11978-1733
US

IV. Provider business mailing address

147 BEACH RD STE A
WESTHAMPTON BEACH NY
11978-1733
US

V. Phone/Fax

Practice location:
  • Phone: 631-288-7746
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number339701
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: