Provider Demographics
NPI:1720155377
Name:YD PODIATRY, PC
Entity Type:Organization
Organization Name:YD PODIATRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:DREYZINA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-708-6121
Mailing Address - Street 1:2440 HUNTER AVE
Mailing Address - Street 2:APT 6B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-5646
Mailing Address - Country:US
Mailing Address - Phone:718-708-6121
Mailing Address - Fax:718-708-5381
Practice Address - Street 1:2440 HUNTER AVE
Practice Address - Street 2:APT 6B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-5646
Practice Address - Country:US
Practice Address - Phone:718-708-6121
Practice Address - Fax:718-708-5381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005747213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU86075Medicare UPIN
NYPUW481Medicare ID - Type Unspecified
NJ057460Medicare ID - Type Unspecified