Provider Demographics
NPI:1427111632
Name:YAVETZ, CAROLINE PENFIELD (MD)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:PENFIELD
Last Name:YAVETZ
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 1:1623 THIRD AVE 4GW
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128
Mailing Address - Country:US
Mailing Address - Phone:212-860-1003
Mailing Address - Fax:
Practice Address - Street 1:151 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901
Practice Address - Country:US
Practice Address - Phone:518-561-7337
Practice Address - Fax:518-561-1335
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164377208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01086837Medicaid