Provider Demographics
NPI:1992901425
Name:KOPYLTSOVA, YELENA (MD)
Entity type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:KOPYLTSOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 WHITE PLAINS RD FL 4
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5139
Mailing Address - Country:US
Mailing Address - Phone:914-984-2546
Mailing Address - Fax:
Practice Address - Street 1:3119 NEWTOWN AVE STE 201
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1392
Practice Address - Country:US
Practice Address - Phone:718-971-2490
Practice Address - Fax:718-971-2489
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251046207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYFK1942641OtherDEA
NYA400131633Medicare PIN