MEDICARE: MRS. CHAVA YANKELEWITZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	847333273	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1114495	OTHER	NY	TEACHER CERTIFICATION NUMBER

General Provider Information

NPI Number	:	1164856324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHAVA YANKELEWITZ

Provider Business Mailing Address
First Line	:	8321 124TH PL
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-2703
Country	:	US
Telephone Number	:	718-846-3472
Fax Number	:

Provider Business Practice Location Address
First Line	:	8321 124TH PL
Second Line	:
City	:	KEW GARDENS
State	:	NY
Zip	:	11415-2703
Country	:	US
Telephone Number	:	718-846-3472
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2013
Last Update Date	:	08/23/2013

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