Provider Demographics
NPI:1346023710
Name:GOZENPUD, YELENA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:YELENA
Middle Name:
Last Name:GOZENPUD
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MONTREAL SQ
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1619
Mailing Address - Country:US
Mailing Address - Phone:917-309-0795
Mailing Address - Fax:
Practice Address - Street 1:4866 US HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-3785
Practice Address - Country:US
Practice Address - Phone:732-426-6898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02933100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist