Individual
DR. DINA YUSUPOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
100 HOSPITAL RD STE 201, EAST PATCHOGUE, NY 11772-8814
(631) 475-6900
Mailing address
100 HOSPITAL RD STE 201, EAST PATCHOGUE, NY 11772-8814
(631) 475-6900
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MA11807000
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/06/2020
Last updated
05/16/2024
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