Provider Demographics
NPI:1720212962
Name:DEACON-MARTIN, YVONNE
Entity Type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:
Last Name:DEACON-MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 AVENUE D
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-7979
Mailing Address - Country:US
Mailing Address - Phone:917-528-4749
Mailing Address - Fax:347-529-2170
Practice Address - Street 1:3020 AVENUE D
Practice Address - Street 2:SUITE 2C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-7979
Practice Address - Country:US
Practice Address - Phone:917-528-4749
Practice Address - Fax:347-529-2170
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle