Provider Demographics
NPI:1821176397
Name:NORMATOV, YANA (RPAC)
Entity Type:Individual
Prefix:MS
First Name:YANA
Middle Name:
Last Name:NORMATOV
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6610 149TH ST APT 4H
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1302
Mailing Address - Country:US
Mailing Address - Phone:718-644-8085
Mailing Address - Fax:
Practice Address - Street 1:6610 149TH ST APT 4H
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1302
Practice Address - Country:US
Practice Address - Phone:718-644-8085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010152363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant