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General NPI Number Information
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NPI Number | 1073129110
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Entity Type | Individual
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Provider Name | YELENA YAKUTILOVA PA
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Gender | Female
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Dates
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Enumeration Date | 09/22/2020
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Last Update Date | 09/22/2020
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Provider Practice Location Address
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Address Line | 5321 FLATLANDS AVE
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City | BROOKLYN
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State | NY
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Zip | 11234-2322
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Country | US
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Telephone | 718-517-2244
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Fax |
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Provider Business Mailing Address
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Address Line | 6333 ALDERTON ST
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City | REGO PARK
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State | NY
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Zip | 11374-2824
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Country | US
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Telephone | 917-843-6436
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 024298
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number | 024298
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 024298
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License Number State | NY
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