Individual
DR. GRIGORIY YUSUPOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
65 JEFFERSON AVENUE, ELIZABETH, NJ 07201
(908) 527-8688
(908) 527-9399
Mailing address
65 JEFFERSON AVENUE, ELIZABETH, NJ 07201
(908) 527-8688
(908) 527-9399
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
220102207500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9069909
—
NJ
Enumeration date
06/20/2008
Last updated
05/01/2012
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