Organization
MEDICAL PRACTICE NY PC
Active
Organization
MEDICAL PRACTICE NY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. YELENA MAMEDOVA-BRAZ MD (OWNER)
(212) 874-0143
Entity
Organization
Contact information
Practice address
5 W 86TH ST APT 1C, NEW YORK, NY 10024-3663
(212) 874-0143
Mailing address
5 W 86TH ST APT 1C, NEW YORK, NY 10024-3663
(212) 874-0143
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
185185
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01274024
—
NY
Enumeration date
04/17/2009
Last updated
11/23/2010
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