Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 129196 | NY |
N | 2084N0402X | Child Neurologist | 249196 | NY |
Y | 2084N0402X | Child Neurologist | 25MB09731300 | NJ |
NPI | 1346476124 |
---|---|
Provider Name | Yelena S Roshchina |
First Address | Hackensack, NJ 07601-1915 |
Second Address | Hackensack, NJ 07601-1915 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2009 |
Last Update Date | 04/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1346476124 | (05) | NJ |