Provider Demographics
NPI:1942365028
Name:YELLIN, PAUL BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:BRIAN
Last Name:YELLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2705
Mailing Address - Country:US
Mailing Address - Phone:516-773-4749
Mailing Address - Fax:516-773-4737
Practice Address - Street 1:24 UNION SQ E # 32
Practice Address - Street 2:6TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3201
Practice Address - Country:US
Practice Address - Phone:646-775-6620
Practice Address - Fax:646-775-6602
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY143713208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB11030Medicare UPIN