Provider Demographics
NPI:1134369564
Name:VINOKUR, YELENA (LAC)
Entity type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:VINOKUR
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 PEMBROKE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2312
Mailing Address - Country:US
Mailing Address - Phone:347-432-1926
Mailing Address - Fax:973-344-4751
Practice Address - Street 1:119 CLIFFORD ST
Practice Address - Street 2:SUITE 103A
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105
Practice Address - Country:US
Practice Address - Phone:973-344-4750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00033000171100000X
NY2171171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist