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NPI Code Detail

MEDICARE: YELENA YERETSKY DO

MEDICARE: YELENA YERETSKY DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207N00000XDermatology Physician25MB07372300NJ

General Provider Information

NPI Number : 1144329830
Entity Type Code : Individual
Provider Name (Legal Business Name) : YELENA YERETSKY DO
Provider Business Mailing Address
First Line : 36 NEWARK AVE
Second Line : SUITE 120
City : BELLEVILLE
State : NJ
Zip : 07109-4120
Country : US
Telephone Number : 973-759-6569
Fax Number : 973-759-2562
Provider Business Practice Location Address
First Line : 36 NEWARK AVE
Second Line : STE 120 LIGRESTI DERMATOLOGY ASSOCIATES PA
City : BELLEVILLE
State : NJ
Zip : 07109-4120
Country : US
Telephone Number : 973-759-6569
Fax Number : 973-759-2562
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2006
Last Update Date : 10/10/2007

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Directions to “ YELENA YERETSKY DO” Practice Location

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