MEDICARE: MRS. YELENA DREYZINA DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	N005747	NY
2	213E00000X	Podiatrist	25MD00268700	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134127632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YELENA DREYZINA DPM

Provider Business Mailing Address
First Line	:	2420 HUNTER AVE
Second Line	:	APT # 9E
City	:	BRONX
State	:	NY
Zip	:	10475-5626
Country	:	US
Telephone Number	:	718-708-6121
Fax Number	:	718-708-5381

Provider Business Practice Location Address
First Line	:	120 ELGAR PL BLDG 34
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10475-5103
Country	:	US
Telephone Number	:	718-708-6121
Fax Number	:	718-708-5381

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	09/21/2016

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