Individual
MR. EMANUEL YUSUPOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
79-01 BROADWAY, ELMHURST, NY 11373
(718) 334-1921
(718) 334-5958
Mailing address
79-01 BROADWAY, ELMHURST, NY 11373
(718) 334-1921
(718) 334-5958
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
014745
NY
Other
Enumeration date
06/09/2011
Last updated
06/09/2011
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