| Medical Practice Ny Pc | |
|
6923 168th St Fresh Meadows NY 11365-3213 | |
| (718) 755-0656 | |
| Not Available |
| Full Name | Medical Practice Ny Pc |
|---|---|
| Speciality | Psychologist - Group Psychotherapy |
| Location | 6923 168th St, Fresh Meadows, New York |
| Authorized Official Name and Position | Yelena Mamedova Braz (MD) |
| Authorized Official Contact | 7187550656 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Medical Practice Ny Pc 95-20 63 Rd Road Suite H Rego Park NY 11374 Ph: (347) 813-4143 | Medical Practice Ny Pc 6923 168th St Fresh Meadows NY 11365-3213 Ph: (718) 755-0656 |
| NPI Number | 1437494648 |
|---|---|
| Provider Enumeration Date | 11/29/2012 |
| Last Update Date | 11/29/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437494648 | NPI | - | NPPES |
| 01274024 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TP2701X | Psychologist - Group Psychotherapy | 185185 (New York) | Primary |
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