Provider Demographics
NPI:1629898432
Name:YOGATASTIC
Entity type:Organization
Organization Name:YOGATASTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NPP
Authorized Official - Prefix:
Authorized Official - First Name:AMALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:191-730-6605
Mailing Address - Street 1:106 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-1717
Mailing Address - Country:US
Mailing Address - Phone:191-730-6605
Mailing Address - Fax:
Practice Address - Street 1:34 HEMPSTEAD AVE
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4734
Practice Address - Country:US
Practice Address - Phone:917-306-6054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty