Provider Demographics
NPI:1922463405
Name:NATANOV, YELENA JR
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:NATANOV
Suffix:JR
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 1:10831 66TH RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2206
Mailing Address - Country:US
Mailing Address - Phone:917-287-3333
Mailing Address - Fax:
Practice Address - Street 1:10831 66TH RD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2206
Practice Address - Country:US
Practice Address - Phone:917-287-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency