Provider Demographics
NPI:1013248103
Name:VEVITSIS, YELENA M (R-PAC)
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:M
Last Name:VEVITSIS
Suffix:
Gender:F
Credentials:R-PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 AVENUE P
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1009
Mailing Address - Country:US
Mailing Address - Phone:718-375-7546
Mailing Address - Fax:718-376-6475
Practice Address - Street 1:1220 AVENUE P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1009
Practice Address - Country:US
Practice Address - Phone:718-375-7546
Practice Address - Fax:718-376-6475
Is Sole Proprietor?:No
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009123207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology