Provider Demographics
NPI:1184889164
Name:REZNIK, YELENA (PT)
Entity type:Individual
Prefix:MRS
First Name:YELENA
Middle Name:
Last Name:REZNIK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2278 E 28TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-5058
Mailing Address - Country:US
Mailing Address - Phone:347-268-7478
Mailing Address - Fax:
Practice Address - Street 1:2940 OCEAN PKWY STE 1A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8210
Practice Address - Country:US
Practice Address - Phone:347-425-9044
Practice Address - Fax:347-425-9045
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026399225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist