Individual
MS. YELENA YUSUPOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8103 192ND ST, HOLLIS, NY 11423-1044
(917) 626-3144
Mailing address
8103 192ND ST, HOLLIS, NY 11423-1044
(917) 626-3144
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
1880957
NY
Other
Enumeration date
06/25/2012
Last updated
06/25/2012
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