Provider Demographics
NPI:1629060991
Name:EDWARD J YELINEK, PC
Entity Type:Organization
Organization Name:EDWARD J YELINEK, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:YELINEK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:717-762-7719
Mailing Address - Street 1:131 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:PA
Mailing Address - Zip Code:17268-1916
Mailing Address - Country:US
Mailing Address - Phone:717-762-7719
Mailing Address - Fax:717-762-1652
Practice Address - Street 1:131 W 5TH ST
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:PA
Practice Address - Zip Code:17268-1916
Practice Address - Country:US
Practice Address - Phone:717-762-7719
Practice Address - Fax:717-762-1652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-004289-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015005680002Medicaid
PA0015005680002Medicaid
PA443921Medicare PIN