Healthcare Provider Details

I. General information

NPI: 1457304438
Provider Name (Legal Business Name): JOLI YUKNEK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DAVIS AVE AT E POST RD HOSPITATLIST DEPT
WHITE PLAINS NY
10601-4615
US

IV. Provider business mailing address

12 CAMBRIDGE DR
TRUMBULL CT
06611-4764
US

V. Phone/Fax

Practice location:
  • Phone: 914-681-0600
  • Fax: 914-681-2285
Mailing address:
  • Phone: 203-372-1900
  • Fax: 203-372-2600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number189840
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA189840
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: