Provider Demographics
NPI:1417102211
Name:YEGOROVA, VERONICA (MS, PT)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:
Last Name:YEGOROVA
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:
Other - Last Name:VERDINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, PT
Mailing Address - Street 1:81 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-3401
Mailing Address - Country:US
Mailing Address - Phone:347-247-8510
Mailing Address - Fax:
Practice Address - Street 1:81 WILLOW ST
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-3401
Practice Address - Country:US
Practice Address - Phone:347-247-8510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0234342251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics