MEDICARE: YELENA BOZO

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	235Z00000X	Speech-Language Pathologist	013993	NY

General Provider Information

NPI Number	:	1396986337
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YELENA BOZO

Provider Business Mailing Address
First Line	:	2643 E 24TH ST
Second Line	:	APT. 2A
City	:	BROOKLYN
State	:	NY
Zip	:	11235-2609
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2643 E 24TH ST
Second Line	:	APT. 2A
City	:	BROOKLYN
State	:	NY
Zip	:	11235-2609
Country	:	US
Telephone Number	:	646-642-9591
Fax Number	:

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

Provider Enumeration Date	:	03/22/2009
Last Update Date	:	03/22/2009

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Directions to “ YELENA BOZO ” Practice Location

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