Provider Demographics
NPI:1801274980
Name:YENIYILDIZ, AHMET
Entity type:Individual
Prefix:MR
First Name:AHMET
Middle Name:
Last Name:YENIYILDIZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 LOCUST LN
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-1027
Mailing Address - Country:US
Mailing Address - Phone:585-770-7070
Mailing Address - Fax:
Practice Address - Street 1:40 LOCUST LN
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-1027
Practice Address - Country:US
Practice Address - Phone:585-770-7070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY560557154172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
47-2955149OtherNEWSTAR TRANSPORT SERVICE