Provider Demographics
NPI:1568402972
Name:SOUTH YONKERS FAMILY MEDICINE,PLLC
Entity Type:Organization
Organization Name:SOUTH YONKERS FAMILY MEDICINE,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARIDAD
Authorized Official - Middle Name:
Authorized Official - Last Name:FRESNEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-237-8282
Mailing Address - Street 1:32 HYATT AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-4311
Mailing Address - Country:US
Mailing Address - Phone:914-237-8282
Mailing Address - Fax:
Practice Address - Street 1:32 HYATT AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-4311
Practice Address - Country:US
Practice Address - Phone:914-237-8282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190207-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0455572OtherAETNA PPO GROUP #
NYDE4256OtherRAILROAD MDCR GROUP #
NY008619OtherAETNA HMO GROUP #
NY5297060001Medicare NSC
NYDE4256OtherRAILROAD MDCR GROUP #
NYWEV061Medicare PIN