Provider Demographics
NPI:1922360338
Name:MURAVINA, YELENA
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:MURAVINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4400
Mailing Address - Country:US
Mailing Address - Phone:718-979-0407
Mailing Address - Fax:
Practice Address - Street 1:1311 55TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-4202
Practice Address - Country:US
Practice Address - Phone:718-851-6100
Practice Address - Fax:718-686-7153
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator