Individual
YULIYA DEMENTYEVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
703 MAIN ST, PATERSON, NJ 07503-2621
(973) 754-3298
Mailing address
703 MAIN ST, PATERSON, NJ 07503-2621
(973) 754-3298
Taxonomy
Speciality
Code
Description
License number
State
2084P0015X
Psychosomatic Medicine Physician
25MA08302400
NJ
2084P0800X
Psychiatry Physician
Primary
25MA08302400
NJ
2084P0805X
Geriatric Psychiatry Physician
25MA08302400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
153079
—
NJ
Enumeration date
06/17/2007
Last updated
07/12/2012
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