Provider Demographics
NPI:1326285529
Name:YANETH ESTRADA
Entity Type:Organization
Organization Name:YANETH ESTRADA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YANETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTRADA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-271-5111
Mailing Address - Street 1:8420 85TH AVE
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-1217
Mailing Address - Country:US
Mailing Address - Phone:917-538-4421
Mailing Address - Fax:718-332-3516
Practice Address - Street 1:1200 GRAVESEND NECK RD
Practice Address - Street 2:SUITE #1A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4256
Practice Address - Country:US
Practice Address - Phone:718-332-3555
Practice Address - Fax:718-332-3516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-10
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005626332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5602300001Medicare NSC