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General NPI Number Information
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NPI Number | 1295227387
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Entity Type | Organization
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Legal Business Name | BACK TO HEALTH MEDICAL CARE PC
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Dates
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Enumeration Date | 06/04/2018
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Last Update Date | 09/06/2024
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Provider Practice Location Address
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Address Line | 690 BROADWAY STE 100
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City | MASSAPEQUA
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State | NY
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Zip | 11758-2371
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Country | US
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Telephone | 516-308-7540
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Fax |
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Provider Business Mailing Address
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Address Line | 690 BROADWAY STE 100
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City | MASSAPEQUA
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State | NY
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Zip | 11758-2371
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Country | US
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Telephone | 917-992-8049
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DARRON YELLING
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Credential | DO
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Telephone | 917-992-8049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 26448
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License Number State | NY
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