Provider Demographics
NPI:1801865852
Name:ANGELOVA, YULIYA (OD)
Entity Type:Individual
Prefix:
First Name:YULIYA
Middle Name:
Last Name:ANGELOVA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 E MERRICK RD
Mailing Address - Street 2:SUIT 201
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-6105
Mailing Address - Country:US
Mailing Address - Phone:516-825-7455
Mailing Address - Fax:516-825-1494
Practice Address - Street 1:10 E MERRICK RD
Practice Address - Street 2:SUITE 201
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-6105
Practice Address - Country:US
Practice Address - Phone:516-825-7455
Practice Address - Fax:516-825-1494
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006566152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02387557Medicaid
NYU92403Medicare UPIN
NYC222H1Medicare ID - Type Unspecified