Individual
EDUARD YUSHUVAYEV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
4500 PARSONS BLVD, FLUSHING, NY 11355-2205
(718) 670-5000
Mailing address
7339 174TH ST, FRESH MEADOWS, NY 11366-1424
(718) 215-0020
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
011719
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011719
NEW YORK STATE LICENSE
NY
Enumeration date
05/22/2008
Last updated
04/23/2020
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