Individual
DR. ELEANOR YUSUPOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
NORTHERN BOULEVARD ACADEMIC HEALTH CARE CENTER, NYIT COLLEGE OF OSTEOPATHIC MEDICINE, OLD WESTBURY, NY 11568-8000
(516) 686-3751
Mailing address
PO BOX 8000, NORTHERN BOULEVARD, ACADEMIC HEALTH CARE CENTER, OLD WESTBURY, NY 11568-8000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
247945
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
247945
NYS LICENSE
NY
Enumeration date
02/12/2009
Last updated
07/09/2014
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