Provider Demographics
NPI:1740806900
Name:KUZNETSOV, YELENA (RN BSN)
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:KUZNETSOV
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:83 BUSTLETON PIKE UNIT C
Mailing Address - Street 2:
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6465
Mailing Address - Country:US
Mailing Address - Phone:215-710-0515
Mailing Address - Fax:215-710-0258
Practice Address - Street 1:83 BUSTLETON PIKE UNIT C
Practice Address - Street 2:
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-6465
Practice Address - Country:US
Practice Address - Phone:215-710-0515
Practice Address - Fax:215-710-0258
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)