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General NPI Number Information
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NPI Number | 1881969178
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Entity Type | Individual
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Provider Name | CHRISTOPHER R YAKAWIAK RPA-C
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Gender | Male
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Dates
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Enumeration Date | 03/20/2012
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Last Update Date | 08/30/2012
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Provider Practice Location Address
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Address Line | 315 S MANNING BLVD MEDICAL IMAGING DEPARTMENT
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City | ALBANY
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State | NY
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Zip | 12208-1707
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Country | US
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Telephone | 518-525-1852
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Fax | 518-525-5187
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Provider Business Mailing Address
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Address Line | 4 ATRIUM DR SUITE 100 CREDENTIALING
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City | ALBANY
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State | NY
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Zip | 12205-1441
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Country | US
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Telephone | 518-435-2740
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Fax | 518-649-4060
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 015653
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License Number State | NY
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