Basic Information
| Provider Information | |||||||||
| NPI: | 1740350339 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | YURKOVETSKAYA | ||||||||
| FirstName: | INNA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 OCEANA DR W | ||||||||
| Address2: | #5 C | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112356651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187570187 | ||||||||
| FaxNumber: | 7186672424 | ||||||||
| Practice Location | |||||||||
| Address1: | 1120 BRIGHTON BEACH AVE | ||||||||
| Address2: | 1 Z | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112355572 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187570187 | ||||||||
| FaxNumber: | 7186672424 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 197264 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 016141199 | 05 | NY | MEDICAID |