Medical Practice Ny PC

Primary specialty

Group Psychotherapy PsychologistTaxonomy code 103TP2701X

License

185185 Issued in NY

Legal business name

MEDICAL PRACTICE NY PC

Practice address

6923 168TH St
Fresh Meadows, NY 11365-3213

Phone

(718) 755-0656

NPI assigned

Nov 29, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Yelena Mamedova Braz, MDNPI 1538319728

Title

MD

Phone

(718) 755-0656

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Yelena Mamedova Braz, MD

  • Psychiatry Physician
  • New York, NY
  • NPI 1538319728
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1354147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1354147200000",
    "number": "1437494648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95-20 63 RD ROAD SUITE H",
            "city": "REGO PARK",
            "state": "NY",
            "postal_code": "11374",
            "telephone_number": "347-813-4143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6923 168TH ST",
            "city": "FRESH MEADOWS",
            "state": "NY",
            "postal_code": "113653213",
            "telephone_number": "718-755-0656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL PRACTICE NY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-29",
        "last_updated": "2012-11-29",
        "status": "A",
        "authorized_official_last_name": "MAMEDOVA BRAZ",
        "authorized_official_first_name": "YELENA",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "718-755-0656",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "103TP2701X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "NY",
            "license": "185185",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01274024",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Group Psychotherapy Psychologist in Fresh Meadows, NY
• Providers in Fresh Meadows, NY by specialty
• Group Psychotherapy Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.