Provider Demographics
NPI:1659838217
Name:HAIMOV, YELENA
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:HAIMOV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:YELENA
Other - Middle Name:
Other - Last Name:HAIMOV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2148 OCEAN AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1484
Mailing Address - Country:US
Mailing Address - Phone:718-375-2502
Mailing Address - Fax:
Practice Address - Street 1:2148 OCEAN AVE STE 302
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1484
Practice Address - Country:US
Practice Address - Phone:718-375-2502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2532687174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist