Provider Demographics
NPI:1205807476
Name:KITAYCHIK, YEVGENIYA (PA)
Entity type:Individual
Prefix:
First Name:YEVGENIYA
Middle Name:
Last Name:KITAYCHIK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2942 W 5TH ST
Mailing Address - Street 2:APT11P
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-3834
Mailing Address - Country:US
Mailing Address - Phone:718-373-3961
Mailing Address - Fax:
Practice Address - Street 1:2942 W 5TH ST APT 9F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-3815
Practice Address - Country:US
Practice Address - Phone:718-373-3961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010355363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant