Provider Demographics
NPI:1417142324
Name:YALDEN, LAURALEE
Entity Type:Individual
Prefix:DR
First Name:LAURALEE
Middle Name:
Last Name:YALDEN
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 1:1345 RXR PLAZA
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11556
Mailing Address - Country:US
Mailing Address - Phone:516-783-4600
Mailing Address - Fax:516-783-4612
Practice Address - Street 1:336 E 86TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-4615
Practice Address - Country:US
Practice Address - Phone:212-913-0828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99769207Q00000X
NY269017207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME99769OtherMEDICAL LICENSE