=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306088042
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YESTERMORROW PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2009
-----------------------------------------------------
Last Update Date | 04/13/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1050 MAIN ST SUITE #18
-----------------------------------------------------
City | EAST GREENWICH
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02818-3161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-886-9669
-----------------------------------------------------
Fax | 401-886-9779
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1050 MAIN ST SUITE #18
-----------------------------------------------------
City | EAST GREENWICH
-----------------------------------------------------
State | RI
-----------------------------------------------------
Zip | 02818-3161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 401-886-9669
-----------------------------------------------------
Fax | 401-886-9779
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | JENNIFER PIACITELLI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 401-886-9669
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QB0002X
-----------------------------------------------------
Taxonomy Name | Obesity Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number | MD10390
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD11488
-----------------------------------------------------
License Number State | RI
-----------------------------------------------------