Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 009123 | NY |
NPI | 1013248103 |
---|---|
Provider Name | Yelena M Vevitsis |
First Address | Brooklyn, NY 11229-1009 |
Second Address | Brooklyn, NY 11229-1009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2010 |
Last Update Date | 29/01/2010 |