Individual
LILIA YAKUTELOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
410 LAKEVILLE RD, NEW HYDE PARK, NY 11042-1101
(718) 470-8784
Mailing address
8318 HOMELAWN ST, JAMAICA, NY 11432-2150
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
059737
NY
363AM0700X
Medical Physician Assistant
Primary
012487
NY
Other
Enumeration date
04/07/2008
Last updated
10/06/2014
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