Provider Demographics
NPI:1376721472
Name:YAROSLAVSKAYA, FIANA I (MPT)
Entity Type:Individual
Prefix:MRS
First Name:FIANA
Middle Name:I
Last Name:YAROSLAVSKAYA
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9952 66TH RD APT 9Z
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4429
Mailing Address - Country:US
Mailing Address - Phone:718-263-6388
Mailing Address - Fax:
Practice Address - Street 1:9952 66TH RD LBBY C
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4461
Practice Address - Country:US
Practice Address - Phone:718-263-6288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2009-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029811-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG300000030OtherMEDICARE GHI