Provider Demographics
NPI:1972729002
Name:YALKOWSKY-KORNREICH, IVA H (OD)
Entity Type:Individual
Prefix:DR
First Name:IVA
Middle Name:H
Last Name:YALKOWSKY-KORNREICH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 DISBROW LN
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10804-3210
Mailing Address - Country:US
Mailing Address - Phone:914-632-0789
Mailing Address - Fax:
Practice Address - Street 1:171 GRAMATAN AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-1205
Practice Address - Country:US
Practice Address - Phone:914-664-0205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005685-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU67867Medicare UPIN