Individual
MRS. YELENA COSSACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
241 FAIRBANKS AVE, STATEN ISLAND, NY 10306-4103
(917) 392-3352
Mailing address
241 FAIRBANKS AVE, STATEN ISLAND, NY 10306-4103
(917) 392-3352
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
1679037231
NY
Other
Enumeration date
05/05/2023
Last updated
05/05/2023
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