Provider Demographics
NPI:1386703338
Name:YAGODA, MICHELLE ROBIN (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ROBIN
Last Name:YAGODA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 E 83RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0401
Mailing Address - Country:US
Mailing Address - Phone:212-434-1210
Mailing Address - Fax:212-535-8155
Practice Address - Street 1:5 E 83RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0401
Practice Address - Country:US
Practice Address - Phone:212-434-1210
Practice Address - Fax:212-535-8155
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182512207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
134038248OtherUNITED HEALTHCARE
134038248OtherUNITED HEALTHCARE
NYG03738Medicare UPIN