Provider Demographics
NPI:1396300406
Name:YASGUR, JAMIE LYNN (MS, LCAT, BC-DMT)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:YASGUR
Suffix:
Gender:F
Credentials:MS, LCAT, BC-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 W 89TH ST APT 4D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1955
Mailing Address - Country:US
Mailing Address - Phone:914-588-8638
Mailing Address - Fax:
Practice Address - Street 1:526 W 26TH ST RM 309
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5518
Practice Address - Country:US
Practice Address - Phone:914-588-8638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002268225600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist