Provider Demographics
NPI:1598920019
Name:KHAYSMAN, YELENA (MD)
Entity type:Individual
Prefix:DR
First Name:YELENA
Middle Name:
Last Name:KHAYSMAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 QUAIL RUN
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-2826
Mailing Address - Country:US
Mailing Address - Phone:973-359-5798
Mailing Address - Fax:
Practice Address - Street 1:35 QUAIL RUN
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-2826
Practice Address - Country:US
Practice Address - Phone:973-359-5798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2546642084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry