Provider Demographics
NPI:1992877591
Name:POPILEVSKAYA, YANA (PA)
Entity type:Individual
Prefix:
First Name:YANA
Middle Name:
Last Name:POPILEVSKAYA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5100 WEST TAFT RD
Mailing Address - Street 2:STE 2E
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088
Mailing Address - Country:US
Mailing Address - Phone:315-634-2541
Mailing Address - Fax:315-634-3395
Practice Address - Street 1:5100 WEST TAFT RD
Practice Address - Street 2:STE 2E
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088
Practice Address - Country:US
Practice Address - Phone:315-634-2541
Practice Address - Fax:315-634-3395
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY007981-1363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CC5280Medicare PIN
970023677Medicare PIN
P29510Medicare UPIN