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Organization

MEDICAL PRACTICE NY PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. YELENA MAMEDOVA BRAZ MD (MD)
(718) 755-0656
Entity
Organization

Contact information

Practice address
6923 168TH ST, FRESH MEADOWS, NY 11365-3213
(718) 755-0656
Mailing address
95-20 63 RD ROAD SUITE H, REGO PARK, NY 11374
(347) 813-4143

Taxonomy

Speciality
Code
Description
License number
State
103TP2701X
Group Psychotherapy Psychologist
Primary
185185
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01274024
NY
Enumeration date
11/29/2012
Last updated
11/29/2012
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