Provider Demographics
NPI:1285674556
Name:YAHNER, PAUL N (PT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:N
Last Name:YAHNER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:13865-4141
Mailing Address - Country:US
Mailing Address - Phone:607-655-2305
Mailing Address - Fax:607-655-2306
Practice Address - Street 1:104 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:13865-4141
Practice Address - Country:US
Practice Address - Phone:607-655-2305
Practice Address - Fax:607-655-2306
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023062174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02533700Medicaid
NYRB6361Medicare PIN
NY02533700Medicaid