Basic Information
| Provider Information | |||||||||
| NPI: | 1699741793 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STONE | ||||||||
| FirstName: | YELENA | ||||||||
| MiddleName: | MATLIN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 48200 | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071018400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5169375000 | ||||||||
| FaxNumber: | 5169312535 | ||||||||
| Practice Location | |||||||||
| Address1: | 530 HICKSVILLE RD | ||||||||
| Address2: | |||||||||
| City: | BETHPAGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117143415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5169375000 | ||||||||
| FaxNumber: | 5169312535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 04/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 229211 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2607174 | 05 | NY | MEDICAID |