Provider Demographics
NPI:1801011010
Name:YELLIN, GENE (CSW)
Entity Type:Individual
Prefix:MR
First Name:GENE
Middle Name:
Last Name:YELLIN
Suffix:
Gender:M
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W 43RD ST APT 33D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-6301
Mailing Address - Country:US
Mailing Address - Phone:212-564-4067
Mailing Address - Fax:212-564-4067
Practice Address - Street 1:24 E 12TH ST RM 505
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4560
Practice Address - Country:US
Practice Address - Phone:212-924-2370
Practice Address - Fax:212-564-4067
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0161181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN08521Medicare ID - Type Unspecified