Provider Demographics
NPI:1699858027
Name:VAYNER, YELENA (MS, PT)
Entity type:Individual
Prefix:MS
First Name:YELENA
Middle Name:
Last Name:VAYNER
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 DOVER ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3721
Mailing Address - Country:US
Mailing Address - Phone:347-528-4411
Mailing Address - Fax:240-524-2499
Practice Address - Street 1:219 DOVER ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3721
Practice Address - Country:US
Practice Address - Phone:347-528-4411
Practice Address - Fax:240-524-2499
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020429225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQP7131Medicare ID - Type UnspecifiedMEDICARE PROVIDER #