Provider Demographics
NPI:1356664783
Name:ROZENFELD-GOFMAN, YELENA
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:ROZENFELD-GOFMAN
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 1:203 BRIGHTON BEACH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7406
Mailing Address - Country:US
Mailing Address - Phone:718-743-1200
Mailing Address - Fax:718-743-1029
Practice Address - Street 1:203 BRIGHTON BEACH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7406
Practice Address - Country:US
Practice Address - Phone:718-743-1200
Practice Address - Fax:718-743-1029
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI046117-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI046117-1OtherNYC BOARD OF PHARMACY