Provider Demographics
NPI:1609054691
Name:REYZELMAN, YELENA (RPH)
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:REYZELMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 POINT VIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2064
Mailing Address - Country:US
Mailing Address - Phone:201-838-5864
Mailing Address - Fax:
Practice Address - Street 1:625 8TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-1415
Practice Address - Country:US
Practice Address - Phone:212-273-0889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046506183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01900623Medicaid