Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | OS016358 | PA |
Y | 207QS0010X | Family Doctor - Sports Medicine | OS016358 | PA |
NPI | 1104112168 |
---|---|
Provider Name | Stephanie Leigh Yellin |
First Address | Woodbury Heights, NJ 08097-1221 |
Second Address | Woodbury Heights, NJ 08097-1221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2011 |
Last Update Date | 18/09/2019 |