Provider Demographics
NPI:1306195672
Name:BANGIYEV, YANNA
Entity Type:Individual
Prefix:MRS
First Name:YANNA
Middle Name:
Last Name:BANGIYEV
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 1:21208 75TH AVE
Mailing Address - Street 2:# 6G
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-3362
Mailing Address - Country:US
Mailing Address - Phone:718-790-1671
Mailing Address - Fax:
Practice Address - Street 1:21208 75TH AVE
Practice Address - Street 2:# 6G
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-3362
Practice Address - Country:US
Practice Address - Phone:718-790-1671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-02
Last Update Date:2012-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY660147121174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator