Provider Demographics
NPI:1003321555
Name:SVETLITSKAYA, YELENA
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:SVETLITSKAYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 BEDFORD AVE # 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-2037
Mailing Address - Country:US
Mailing Address - Phone:908-240-8255
Mailing Address - Fax:
Practice Address - Street 1:165 BEDFORD AVE # 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-2037
Practice Address - Country:US
Practice Address - Phone:908-240-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist