Provider Demographics
NPI:1114547767
Name:ELINA YUSHUVAYEV MD, P.C.
Entity type:Organization
Organization Name:ELINA YUSHUVAYEV MD, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ATTENDING
Authorized Official - Prefix:DR
Authorized Official - First Name:ELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSHUVAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-215-0020
Mailing Address - Street 1:22215 NORTHERN BLVD STE LOBBYA
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3678
Mailing Address - Country:US
Mailing Address - Phone:718-215-0020
Mailing Address - Fax:616-226-4785
Practice Address - Street 1:22215 NORTHERN BLVD LBBY A
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3603
Practice Address - Country:US
Practice Address - Phone:718-215-0020
Practice Address - Fax:616-226-4785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-23
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty