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General NPI Number Information
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NPI Number | 1720072036
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Entity Type | Individual
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Provider Name | EDWARD JOHN YATCO MD
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Gender | Male
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Dates
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Enumeration Date | 09/01/2005
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Last Update Date | 07/11/2007
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Provider Practice Location Address
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Address Line | 19 BRADHURST AVE SUITE 1700
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City | HAWTHORNE
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State | NY
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Zip | 10532-2140
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Country | US
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Telephone | 914-347-0162
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Fax | 914-347-4401
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Provider Business Mailing Address
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Address Line | 22 SAW MILL RIVER RD
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City | HAWTHORNE
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State | NY
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Zip | 10532-1533
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Country | US
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Telephone | 914-593-1606
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Fax | 914-593-1790
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 226637
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License Number State | NY
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