Provider Demographics
NPI:1104580463
Name:SARKISYAN, ELINA ROMANOVNA (MA, CMF)
Entity type:Individual
Prefix:
First Name:ELINA
Middle Name:ROMANOVNA
Last Name:SARKISYAN
Suffix:
Gender:F
Credentials:MA, CMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-3247
Mailing Address - Country:US
Mailing Address - Phone:917-909-1790
Mailing Address - Fax:
Practice Address - Street 1:721 HENRY ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-3247
Practice Address - Country:US
Practice Address - Phone:917-909-1790
Practice Address - Fax:929-481-8500
Is Sole Proprietor?:No
Enumeration Date:2021-10-23
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA2036008224900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter