Organization
COMMUNITY RELATED SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. YELENA MAMEDOVA-BRAZ M.D. (MEDICAL DIRECTOR)
(718) 997-1901
Entity
Organization
Contact information
Practice address
9907 QUEENS BLVD, 2ND FLOOR, REGO PARK, NY 11374-4512
(718) 997-1901
(718) 997-9259
Mailing address
99-07 QUEENS BLVD, 2ND FLOOR, REGO PARK, NY 11374
(718) 997-1901
(718) 997-9259
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01827816
—
NY
Enumeration date
11/30/2007
Last updated
11/30/2007
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