Provider Demographics
NPI:1740350339
Name:YURKOVETSKAYA, INNA (MD)
Entity type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:YURKOVETSKAYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 OCEANA DR W
Mailing Address - Street 2:#5 C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6651
Mailing Address - Country:US
Mailing Address - Phone:718-757-0187
Mailing Address - Fax:718-667-2424
Practice Address - Street 1:1120 BRIGHTON BEACH AVE
Practice Address - Street 2:1 Z
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5572
Practice Address - Country:US
Practice Address - Phone:718-757-0187
Practice Address - Fax:718-667-2424
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1972642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY016141199Medicaid
NY28M621Medicare ID - Type Unspecified