Provider Demographics
NPI:1811237480
Name:PETROVA, YULIYA (MS, MA)
Entity Type:Individual
Prefix:
First Name:YULIYA
Middle Name:
Last Name:PETROVA
Suffix:
Gender:F
Credentials:MS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 EBBITTS ST APT 4T
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-4839
Mailing Address - Country:US
Mailing Address - Phone:718-593-9909
Mailing Address - Fax:
Practice Address - Street 1:30 EBBITTS ST APT 4T
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-4839
Practice Address - Country:US
Practice Address - Phone:718-593-9909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1252461174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist