Healthcare Provider Details

I. General information

NPI: 1023432119
Provider Name (Legal Business Name): YEDIDA SEFF MS,ED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2014
Last Update Date: 11/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 E 23RD ST
BROOKLYN NY
11210-3622
US

IV. Provider business mailing address

932 E 23RD ST
BROOKLYN NY
11210-3622
US

V. Phone/Fax

Practice location:
  • Phone: 718-258-2143
  • Fax: 718-258-2143
Mailing address:
  • Phone: 718-258-2143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1023432119
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: