Healthcare Provider Details

I. General information

NPI: 1831766328
Provider Name (Legal Business Name): LYLE VINCENT YAP-SEPAROVICH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 TIBBETTS RD
YONKERS NY
10705-2668
US

IV. Provider business mailing address

239 TIBBETTS RD
YONKERS NY
10705-2668
US

V. Phone/Fax

Practice location:
  • Phone: 917-580-2719
  • Fax:
Mailing address:
  • Phone: 917-580-2719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number332194
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number332194
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: