Provider Demographics
NPI:1619336567
Name:VERETENNIKOVA, YULIA
Entity Type:Individual
Prefix:
First Name:YULIA
Middle Name:
Last Name:VERETENNIKOVA
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 1:3133 BRIGHTON 7TH ST
Mailing Address - Street 2:APT 6CL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6565
Mailing Address - Country:US
Mailing Address - Phone:718-813-2823
Mailing Address - Fax:
Practice Address - Street 1:3133 BRIGHTON 7TH ST
Practice Address - Street 2:APT 6CL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6565
Practice Address - Country:US
Practice Address - Phone:718-813-2823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-21
Last Update Date:2023-11-15
Deactivation Date:2023-08-23
Deactivation Code:
Reactivation Date:2023-11-14
Provider Licenses
StateLicense IDTaxonomies
NY008651224Z00000X
NY028033225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant