MEDICARE: DR. YELENA NUTSKOVSKY DMD

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	1223G0001X	General Practice Dentistry	049884	NY

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

General Provider Information

NPI Number	:	1932154382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YELENA NUTSKOVSKY DMD

Provider Business Mailing Address
First Line	:	237 MABEL PL
Second Line	:
City	:	FRANKLIN LAKES
State	:	NJ
Zip	:	07417-3008
Country	:	US
Telephone Number	:	201-485-8843
Fax Number	:

Provider Business Practice Location Address
First Line	:	375 W ROUTE 59
Second Line	:
City	:	SPRING VALLEY
State	:	NY
Zip	:	10977-5360
Country	:	US
Telephone Number	:	845-352-5410
Fax Number	:	845-352-5412

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	07/08/2007

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