Provider Demographics
NPI:1255355632
Name:YANKILEVICH, LEO (MD)
Entity type:Individual
Prefix:
First Name:LEO
Middle Name:
Last Name:YANKILEVICH
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 1:2026 OCEAN AVE
Mailing Address - Street 2:1B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230
Mailing Address - Country:US
Mailing Address - Phone:718-645-9236
Mailing Address - Fax:718-645-9228
Practice Address - Street 1:2026 OCEAN AVE
Practice Address - Street 2:1B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230
Practice Address - Country:US
Practice Address - Phone:718-645-9236
Practice Address - Fax:718-645-9228
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199964207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01601192Medicaid
G16125Medicare UPIN
NY45J051Medicare PIN