Provider Demographics
NPI:1144329830
Name:YERETSKY, YELENA (DO)
Entity type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:YERETSKY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 NEWARK AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-4120
Mailing Address - Country:US
Mailing Address - Phone:973-759-6569
Mailing Address - Fax:973-759-2562
Practice Address - Street 1:36 NEWARK AVE
Practice Address - Street 2:STE 120 LIGRESTI DERMATOLOGY ASSOCIATES PA
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-4120
Practice Address - Country:US
Practice Address - Phone:973-759-6569
Practice Address - Fax:973-759-2562
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07372300207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology