Individual
JASON YECHIEL ELYAGUOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
19 BRADHURST AVE STE 1900, HAWTHORNE, NY 10532-2137
(914) 347-1900
(914) 347-1957
Mailing address
19 BRADHURST AVE STE 1900, HAWTHORNE, NY 10532-2137
(914) 347-1900
(914) 347-1957
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
314979
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07125051
—
NY
Enumeration date
04/04/2017
Last updated
09/11/2023
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