Provider Demographics
NPI:1033185574
Name:YELLIN, JOEL A (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:A
Last Name:YELLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-922-4715
Mailing Address - Fax:585-922-3950
Practice Address - Street 1:1415 PORTLAND AVE
Practice Address - Street 2:MOB SUITE 245
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3038
Practice Address - Country:US
Practice Address - Phone:585-922-4715
Practice Address - Fax:585-922-3950
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY123527208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2004481912Medicaid
NY2004481912Medicaid
NYB76775Medicare UPIN