Healthcare Provider Details

I. General information

NPI: 1225075179
Provider Name (Legal Business Name): YELENA OGNEVA DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9785 QUEENS BLVD
REGO PARK NY
11374-3319
US

IV. Provider business mailing address

9785 QUEENS BLVD
REGO PARK NY
11374-3319
US

V. Phone/Fax

Practice location:
  • Phone: 718-261-9100
  • Fax: 718-897-2915
Mailing address:
  • Phone: 718-261-9100
  • Fax: 718-897-2915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberN006154
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: