Provider Demographics
NPI:1679844732
Name:YAPCHULAY, MARY JANE ABLAZA
Entity type:Individual
Prefix:
First Name:MARY JANE
Middle Name:ABLAZA
Last Name:YAPCHULAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8702 188TH ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-1104
Mailing Address - Country:US
Mailing Address - Phone:917-208-2479
Mailing Address - Fax:
Practice Address - Street 1:8702 188TH ST
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-1104
Practice Address - Country:US
Practice Address - Phone:917-208-2479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-21
Last Update Date:2012-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306005-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse