Healthcare Provider Details

I. General information

NPI: 1699710517
Provider Name (Legal Business Name): YEKATERINA KUZNETSOVA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 37TH AVE
JACKSON HEIGHTS NY
11372-7011
US

IV. Provider business mailing address

3141 45TH ST
LONG ISLAND CITY NY
11103-1621
US

V. Phone/Fax

Practice location:
  • Phone: 718-335-7600
  • Fax: 718-507-5298
Mailing address:
  • Phone: 718-721-1500
  • Fax: 718-777-1623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number236124
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: