Provider Demographics
NPI:1417279464
Name:BELCHIKOV, YULY
Entity Type:Individual
Prefix:
First Name:YULY
Middle Name:
Last Name:BELCHIKOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3597
Mailing Address - Country:US
Mailing Address - Phone:516-431-4422
Mailing Address - Fax:516-431-4468
Practice Address - Street 1:23 E PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3597
Practice Address - Country:US
Practice Address - Phone:516-431-4422
Practice Address - Fax:516-431-4468
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047782183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist