Provider Demographics
NPI:1699147520
Name:YELLIN, ROSS
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:
Last Name:YELLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 GLOUCESTER CT
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3319
Mailing Address - Country:US
Mailing Address - Phone:908-616-5091
Mailing Address - Fax:
Practice Address - Street 1:19 GLOUCESTER CT
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3319
Practice Address - Country:US
Practice Address - Phone:908-616-5091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist