Provider Demographics
NPI:1619414406
Name:YELENA KORSHUNOV
Entity Type:Organization
Organization Name:YELENA KORSHUNOV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEIT
Authorized Official - Prefix:MS
Authorized Official - First Name:YELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:KORSHUNOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-602-0920
Mailing Address - Street 1:3755 HENRY HUDSON PKWY
Mailing Address - Street 2:APT.6D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1535
Mailing Address - Country:US
Mailing Address - Phone:347-602-0920
Mailing Address - Fax:
Practice Address - Street 1:3755 HENRY HUDSON PKWY
Practice Address - Street 2:APT.6D
Practice Address - City:RIVERDALE
Practice Address - State:NY
Practice Address - Zip Code:10463
Practice Address - Country:US
Practice Address - Phone:347-602-0920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty