Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207K00000X | Allergist & Immunologist | 024298 | NY |
Y | 207RP1001X | Pulmonary Disease | 024298 | NY |
N | 207RS0012X | Sleep Medicine | 024298 | NY |
NPI | 1073129110 |
---|---|
Provider Name | Yelena Yakutilova |
First Address | Rego Park, NY 11374-2824 |
Second Address | Brooklyn, NY 11234-2322 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2020 |
Last Update Date | 22/09/2020 |