Provider Demographics
NPI:1245255538
Name:YACOVONE, JOSEPH FRED (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:FRED
Last Name:YACOVONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-0029
Mailing Address - Country:US
Mailing Address - Phone:845-615-1141
Mailing Address - Fax:845-294-4366
Practice Address - Street 1:75 CRYSTAL RUN RD
Practice Address - Street 2:HORTON PAVILION
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940
Practice Address - Country:US
Practice Address - Phone:845-343-0616
Practice Address - Fax:845-343-0617
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1426452085N0904X, 2085R0202X
NJ25MA066599002085N0904X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00851345Medicaid
NYA98228Medicare UPIN
NY00851345Medicaid