Individual
ELANA YUSUPOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
8311 139TH ST APT 1H, JAMAICA, NY 11435-1602
(917) 209-5745
Mailing address
8311 139TH ST APT 1H, JAMAICA, NY 11435-1602
(917) 209-5745
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
013981
NY
Other
Enumeration date
04/19/2010
Last updated
04/19/2010
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