Provider Demographics
NPI:1174733018
Name:YORKE, PHILIP CHARLES (PH D)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:CHARLES
Last Name:YORKE
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 HALSEY ST
Mailing Address - Street 2:
Mailing Address - City:TRUMANSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14886-9531
Mailing Address - Country:US
Mailing Address - Phone:607-227-8571
Mailing Address - Fax:607-387-5751
Practice Address - Street 1:12 HALSEY ST
Practice Address - Street 2:
Practice Address - City:TRUMANSBURG
Practice Address - State:NY
Practice Address - Zip Code:14886-9531
Practice Address - Country:US
Practice Address - Phone:607-227-8571
Practice Address - Fax:607-387-5751
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007168103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
50999BMedicare ID - Type Unspecified