Provider Demographics
NPI:1306933981
Name:YOMTOBIAN, ISABEL (PT)
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:
Last Name:YOMTOBIAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 NORTHERN BLVD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5312
Mailing Address - Country:US
Mailing Address - Phone:516-627-0303
Mailing Address - Fax:516-627-1399
Practice Address - Street 1:1000 NORTHERN BLVD
Practice Address - Street 2:SUITE 270
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5312
Practice Address - Country:US
Practice Address - Phone:516-627-0303
Practice Address - Fax:516-627-1399
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0259021174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0259021Other1199
0142696OtherGHI
0194347OtherGHI
IY0Q93G010OtherBLUE SHIELD
P3807037OtherOXFORD
Q27G51Medicare PIN