Provider Demographics
NPI:1861472839
Name:STAHL, YOLANDA (DPM)
Entity Type:Individual
Prefix:DR
First Name:YOLANDA
Middle Name:
Last Name:STAHL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:YOLANDA
Other - Middle Name:
Other - Last Name:PINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:1457 MERRICK AVENUE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566
Mailing Address - Country:US
Mailing Address - Phone:516-796-1800
Mailing Address - Fax:516-796-1818
Practice Address - Street 1:1457 MERRICK AVENUE
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566
Practice Address - Country:US
Practice Address - Phone:516-796-1800
Practice Address - Fax:516-796-1818
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0056721213E00000X, 213EP0504X, 213EP1101X, 213ER0200X, 213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic Medicine
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPB9391Medicare PIN
NYU81525Medicare UPIN
NY4898740001Medicare NSC
NY04224Medicare PIN