Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 018511-1 | NY |
NPI | 1063641082 |
---|---|
Provider Name | Yelena Fisher |
First Address | Staten Island, NY 10314-3839 |
Second Address | Staten Island, NY 10314-3839 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2009 |
Last Update Date | 12/07/2009 |