Healthcare Provider Details

I. General information

NPI: 1710043401
Provider Name (Legal Business Name): SAMUEL YARECK III BC-HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MCKEAN AVE
CHARLEROI PA
15022-1407
US

IV. Provider business mailing address

1081 SADDLECLUB DR
CANONSBURG PA
15317-2759
US

V. Phone/Fax

Practice location:
  • Phone: 724-489-9565
  • Fax: 724-489-9566
Mailing address:
  • Phone: 724-942-3169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberF02201
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: