Healthcare Provider Details

I. General information

NPI: 1457691024
Provider Name (Legal Business Name): YULIA KUZNETSOVA ASSOCIATED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2013
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8828 75TH AVE
GLENDALE NY
11385-7926
US

IV. Provider business mailing address

8828 75TH AVE
GLENDALE NY
11385-7926
US

V. Phone/Fax

Practice location:
  • Phone: 718-760-8709
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number555778
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number555778
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number555778
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: