Provider Demographics
NPI:1659169878
Name:LOGAN, YVONNE
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:LOGAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 PARK AVE APT 920W
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-4190
Mailing Address - Country:US
Mailing Address - Phone:917-406-2099
Mailing Address - Fax:
Practice Address - Street 1:1465 PARK AVE APT 920W
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-4190
Practice Address - Country:US
Practice Address - Phone:917-406-2099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist