Provider Demographics
NPI:1629254727
Name:YELINEK, EDWARD J (PHD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:J
Last Name:YELINEK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004289L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015005680002Medicaid
PAYE443921Medicare PIN
R06989Medicare UPIN