Healthcare Provider Details

I. General information

NPI: 1497154801
Provider Name (Legal Business Name): YULIA KUZMITSKAYA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 08/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8512 20TH AVE
BROOKLYN NY
11214-3202
US

IV. Provider business mailing address

308 E 38TH ST APT 15D
NEW YORK NY
10016-9824
US

V. Phone/Fax

Practice location:
  • Phone: 718-333-0395
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number059423
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: