Provider Demographics
NPI:1760858476
Name:YELYEV, VLADIMIR (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:VLADIMIR
Middle Name:
Last Name:YELYEV
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 OCEAN AVE
Mailing Address - Street 2:UNIT 1F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3576
Mailing Address - Country:US
Mailing Address - Phone:718-775-8966
Mailing Address - Fax:718-744-2840
Practice Address - Street 1:2409 OCEAN AVE
Practice Address - Street 2:UNIT 1F
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3576
Practice Address - Country:US
Practice Address - Phone:718-775-8966
Practice Address - Fax:718-744-2840
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY39320174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist