Basic Information
| Provider Information | |||||||||
| NPI: | 1710043401 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YARECK | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | BC-HIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1081 SADDLECLUB DR | ||||||||
| Address2: | |||||||||
| City: | CANONSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153172759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249423169 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2 MCKEAN AVE | ||||||||
| Address2: | |||||||||
| City: | CHARLEROI | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150221407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7244899565 | ||||||||
| FaxNumber: | 7244899566 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | F02201 | PA | Y | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |
No ID Information.