Provider Demographics
NPI:1710023981
Name:BARON YURKEW, ANDREA (RD, CDE)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:BARON YURKEW
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 MAIN ST
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-6922
Mailing Address - Country:US
Mailing Address - Phone:631-754-6916
Mailing Address - Fax:631-754-6916
Practice Address - Street 1:124 MAIN ST STE 6A
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-6922
Practice Address - Country:US
Practice Address - Phone:631-754-6916
Practice Address - Fax:631-754-6916
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM003711-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY09Q302Medicare UPIN