Provider Demographics
NPI:1164856324
Name:YANKELEWITZ, CHAVA
Entity Type:Individual
Prefix:MRS
First Name:CHAVA
Middle Name:
Last Name:YANKELEWITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8321 124TH PL
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-2703
Mailing Address - Country:US
Mailing Address - Phone:718-846-3472
Mailing Address - Fax:
Practice Address - Street 1:8321 124TH PL
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-2703
Practice Address - Country:US
Practice Address - Phone:718-846-3472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY847333273174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1114495OtherTEACHER CERTIFICATION NUMBER