Provider Demographics
NPI:1639224587
Name:VAYSMAN, YELENA (DDS)
Entity Type:Individual
Prefix:DR
First Name:YELENA
Middle Name:
Last Name:VAYSMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 KINGS HWY
Mailing Address - Street 2:4F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1669
Mailing Address - Country:US
Mailing Address - Phone:718-554-7798
Mailing Address - Fax:
Practice Address - Street 1:1201 OCEAN PKWY
Practice Address - Street 2:DENTAL OFFICE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5153
Practice Address - Country:US
Practice Address - Phone:718-554-7798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0467191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01714658Medicaid
NY01714658Medicaid