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General NPI Number Information
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NPI Number | 1720155377
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Entity Type | Organization
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Legal Business Name | YD PODIATRY, PC
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 09/20/2012
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Provider Practice Location Address
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Address Line | 2440 HUNTER AVE APT 6B
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City | BRONX
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State | NY
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Zip | 10475-5646
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Country | US
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Telephone | 718-708-6121
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Fax | 718-708-5381
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Provider Business Mailing Address
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Address Line | 2440 HUNTER AVE APT 6B
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City | BRONX
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State | NY
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Zip | 10475-5646
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Country | US
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Telephone | 718-708-6121
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Fax | 718-708-5381
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Authorized Official
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Title or Position | DIRECTOR
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Name | YELENA DREYZINA
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Credential | DPM
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Telephone | 718-708-6121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 005747
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License Number State | NY
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