Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 030747 | NY |
NPI | 1003060583 |
---|---|
Provider Name | Yelena Dikun |
First Address | Brooklyn, NY 11235-8388 |
Second Address | Brooklyn, NY 11235-8388 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2008 |
Last Update Date | 10/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
030747 | LICENSE NUMBER (01) | NY |