Provider Demographics
NPI:1528381340
Name:VISHNEVETSKY, ELLA (BA)
Entity Type:Individual
Prefix:
First Name:ELLA
Middle Name:
Last Name:VISHNEVETSKY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1426 VIAN AVE
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1423
Mailing Address - Country:US
Mailing Address - Phone:718-337-1900
Mailing Address - Fax:718-337-2277
Practice Address - Street 1:495 BEACH 20TH ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-3621
Practice Address - Country:US
Practice Address - Phone:718-337-1900
Practice Address - Fax:718-337-2277
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047337183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist