Provider Demographics
NPI:1902137003
Name:KORNITSKY, YURY (RPH)
Entity Type:Individual
Prefix:MR
First Name:YURY
Middle Name:
Last Name:KORNITSKY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 LONGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:NY
Mailing Address - Zip Code:12015-2700
Mailing Address - Country:US
Mailing Address - Phone:516-567-1667
Mailing Address - Fax:
Practice Address - Street 1:1101 BRIGHTON BEACH AVE
Practice Address - Street 2:ALL AMERICAN DRUGGIST, INC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5558
Practice Address - Country:US
Practice Address - Phone:718-891-2801
Practice Address - Fax:718-743-5804
Is Sole Proprietor?:No
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036403183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist