Provider Demographics
NPI:1518423326
Name:HAUZENBERG, YANA
Entity Type:Individual
Prefix:
First Name:YANA
Middle Name:
Last Name:HAUZENBERG
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 1:312 HAMDEN AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-5135
Mailing Address - Country:US
Mailing Address - Phone:718-986-8804
Mailing Address - Fax:
Practice Address - Street 1:312 HAMDEN AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-5135
Practice Address - Country:US
Practice Address - Phone:718-986-8804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-17
Last Update Date:2019-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist