Healthcare Provider Details

I. General information

NPI: 1639518848
Provider Name (Legal Business Name): NEW YORK PROFESSIONAL MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2444 86TH ST
BROOKLYN NY
11214
US

IV. Provider business mailing address

PO BOX 32
NORTHBROOK IL
60065-0032
US

V. Phone/Fax

Practice location:
  • Phone: 847-593-8460
  • Fax: 224-246-8042
Mailing address:
  • Phone: 847-593-8460
  • Fax: 224-246-8042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. YAN KATSNELSON
Title or Position: OWNER
Credential: MD
Phone: 847-593-8460