Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 25MA09314400 | NJ |
NPI | 1003124165 |
---|---|
Provider Name | Yelena Pyatov |
First Address | Forest Hills, NY 11375-4148 |
Second Address | New Hyde Park, NY 11040-1402 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2010 |
Last Update Date | 12/05/2014 |