MEDICARE: YELENA ROZENFELD-GOFMAN

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
1	183500000X	Pharmacist	I046117-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	I046117-1	OTHER	NY	NYC BOARD OF PHARMACY

General Provider Information

NPI Number	:	1356664783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YELENA ROZENFELD-GOFMAN

Provider Business Mailing Address
First Line	:	203 BRIGHTON BEACH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-7406
Country	:	US
Telephone Number	:	718-743-1200
Fax Number	:	718-743-1029

Provider Business Practice Location Address
First Line	:	203 BRIGHTON BEACH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-7406
Country	:	US
Telephone Number	:	718-743-1200
Fax Number	:	718-743-1029

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2010
Last Update Date	:	03/12/2010

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