Provider Demographics
NPI:1134127632
Name:DREYZINA, YELENA (DPM)
Entity Type:Individual
Prefix:MRS
First Name:YELENA
Middle Name:
Last Name:DREYZINA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 HUNTER AVE
Mailing Address - Street 2:APT # 9E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-5626
Mailing Address - Country:US
Mailing Address - Phone:718-708-6121
Mailing Address - Fax:718-708-5381
Practice Address - Street 1:120 ELGAR PL BLDG 34
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-5103
Practice Address - Country:US
Practice Address - Phone:718-708-6121
Practice Address - Fax:718-708-5381
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005747213E00000X
NJ25MD00268700213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02264217Medicaid
NJ8821003Medicaid
NY86075Medicare UPIN
NY02264217Medicaid
NY86075Medicare UPIN