=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659013886
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PERRY K YAZZOLINO DO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/08/2022
-----------------------------------------------------
Last Update Date | 12/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 147 BEACH RD STE A
-----------------------------------------------------
City | WESTHAMPTON BEACH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11978-1733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-288-7746
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 147 BEACH RD STE A
-----------------------------------------------------
City | WESTHAMPTON BEACH
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11978-1733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 339701
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------