Provider Demographics
NPI:1235492174
Name:YANKELSON, JAN (MSED)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:YANKELSON
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4625 BEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2611
Mailing Address - Country:US
Mailing Address - Phone:718-769-2801
Mailing Address - Fax:
Practice Address - Street 1:4625 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2611
Practice Address - Country:US
Practice Address - Phone:718-769-2801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYMS SPECIAL ED174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist