Provider Demographics
NPI:1427143296
Name:KOZLYANSKY, YELENA (DC)
Entity type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:KOZLYANSKY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 FRONT ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-1006
Mailing Address - Country:US
Mailing Address - Phone:646-318-1884
Mailing Address - Fax:718-504-7630
Practice Address - Street 1:77 FRONT ST FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1006
Practice Address - Country:US
Practice Address - Phone:646-318-1884
Practice Address - Fax:718-504-7630
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010979111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX06D41Medicare PIN
NYV08709Medicare UPIN