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General NPI Number Information
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NPI Number | 1972729002
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Entity Type | Individual
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Provider Name | IVA H YALKOWSKY-KORNREICH O.D.
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Gender | Female
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 171 GRAMATAN AVE
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City | MOUNT VERNON
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State | NY
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Zip | 10550-1205
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Country | US
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Telephone | 914-664-0205
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Fax |
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Provider Business Mailing Address
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Address Line | 87 DISBROW LN
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City | NEW ROCHELLE
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State | NY
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Zip | 10804-3210
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Country | US
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Telephone | 914-632-0789
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Fax |
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV005685-1
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License Number State | NY
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