Provider Demographics
NPI:1427188598
Name:SHALOMOFF, YARON (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:YARON
Middle Name:
Last Name:SHALOMOFF
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 DAKOTA DR STE 310
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1136
Mailing Address - Country:US
Mailing Address - Phone:516-390-2400
Mailing Address - Fax:
Practice Address - Street 1:1 DAKOTA DR STE 310
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1136
Practice Address - Country:US
Practice Address - Phone:516-390-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006022363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty