Provider Demographics
NPI:1821045295
Name:GEORGES, YOLETTE (PA)
Entity Type:Individual
Prefix:
First Name:YOLETTE
Middle Name:
Last Name:GEORGES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 13700-1760
Mailing Address - Street 2:BROOKDALE EMERGENCY PHYSICIANS ASSOCIATES
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19191-0001
Mailing Address - Country:US
Mailing Address - Phone:718-240-5180
Mailing Address - Fax:610-617-6280
Practice Address - Street 1:1 BROOKDALE PLZ
Practice Address - Street 2:BROOKDALE UNIVERSITY HOSPITAL & MEDICAL CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3139
Practice Address - Country:US
Practice Address - Phone:718-240-5180
Practice Address - Fax:610-617-6280
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005228363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02161604Medicaid
NYP34814Medicare UPIN