Provider Demographics
NPI:1205979945
Name:YELLIN, JEFFREY (DPT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:YELLIN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1889 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-2522
Mailing Address - Country:US
Mailing Address - Phone:516-659-4904
Mailing Address - Fax:
Practice Address - Street 1:1889 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-2522
Practice Address - Country:US
Practice Address - Phone:516-659-4904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028766225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ115GQ4FH1OtherMEDICARE PTAN