Provider Demographics
NPI:1720001787
Name:CHAUMIN, YANICK (MD)
Entity Type:Individual
Prefix:DR
First Name:YANICK
Middle Name:
Last Name:CHAUMIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9412 59TH AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5151
Mailing Address - Country:US
Mailing Address - Phone:718-592-0707
Mailing Address - Fax:718-592-0789
Practice Address - Street 1:9412 59TH AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5151
Practice Address - Country:US
Practice Address - Phone:718-592-0707
Practice Address - Fax:718-592-0789
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156363174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12797POtherHIP PRIS
NYP691456OtherOXFORD PROVIDER ID
NY12797POtherHIP PRIS
NY66200Medicare ID - Type Unspecified