Healthcare Provider Details

I. General information

NPI: 1023212065
Provider Name (Legal Business Name): MS. YANA TSERKUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 05/23/2021
Certification Date: 05/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6152 VERDE TRL N
BOCA RATON FL
33433-2430
US

IV. Provider business mailing address

47 EAST 51 STREET
BAYONNE NJ
07002-4116
US

V. Phone/Fax

Practice location:
  • Phone: 561-299-5429
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number46TR00365500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT17703
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: