Healthcare Provider Details

I. General information

NPI: 1639131030
Provider Name (Legal Business Name): ROBERT F YELLENIK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 05/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 HECKEL RD STE 112
MC KEES ROCKS PA
15136-1616
US

IV. Provider business mailing address

27 HECKEL RD STE 112
MC KEES ROCKS PA
15136-1616
US

V. Phone/Fax

Practice location:
  • Phone: 412-777-4380
  • Fax: 412-777-4385
Mailing address:
  • Phone: 412-777-4380
  • Fax: 412-777-4385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD039756L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier252809
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUPMC
# 2
Identifier60685
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerUNISON
# 3
IdentifierP000282
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerGATEWAY
# 4
Identifier0012863970014
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 5
Identifier153401
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHEALTH AMERICA
# 6
Identifier4516237
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerAETNA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: