Provider Demographics
NPI:1114910858
Name:YELEN, WILLIAM R
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:R
Last Name:YELEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 W PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-1535
Mailing Address - Country:US
Mailing Address - Phone:631-424-2047
Mailing Address - Fax:631-424-2047
Practice Address - Street 1:261 W PULASKI RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-1535
Practice Address - Country:US
Practice Address - Phone:631-424-2047
Practice Address - Fax:631-424-2047
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0252581041C0700X
NJ44SC001265001041C0700X
MA1076811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R27919Medicare UPIN
NYN50381Medicare PIN