Healthcare Provider Details

I. General information

NPI: 1235706136
Provider Name (Legal Business Name): GANNA YABLONSKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2743 OCEAN AVE
BROOKLYN NY
11229-4707
US

IV. Provider business mailing address

602 AVENUE T APT 3C
BROOKLYN NY
11223-4119
US

V. Phone/Fax

Practice location:
  • Phone: 718-646-6738
  • Fax:
Mailing address:
  • Phone: 917-605-8896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: