Individual
ELINA GAVRILOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R-PAC
Contact information
Practice address
3141 45TH ST, LONG ISLAND CITY, NY 11103-1621
(718) 721-1500
(718) 777-1623
Mailing address
3141 45TH ST, LONG ISLAND CITY, NY 11103-1621
(718) 721-1500
(718) 777-1623
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
011611
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11-2990594
GROUP TAX ID
NY
Enumeration date
06/07/2007
Last updated
07/08/2007
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