Healthcare Provider Details

I. General information

NPI: 1871083899
Provider Name (Legal Business Name): NEW YORK JEWISH AMERICAN PODIATRY PRACTICE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3079 BRIGHTON 13TH ST FL 1
BROOKLYN NY
11235
US

IV. Provider business mailing address

3079 BRIGHTON 13TH ST FL 1
BROOKLYN NY
11235-5607
US

V. Phone/Fax

Practice location:
  • Phone: 718-554-3862
  • Fax: 718-554-0979
Mailing address:
  • Phone: 718-554-3862
  • Fax: 718-554-0979

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberN005994-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN005994-1
License Number StateNY

VIII. Authorized Official

Name: YELENA VORONOVA
Title or Position: MEMBER
Credential: DPM
Phone: 718-554-3862