Provider Demographics
NPI:1003943101
Name:MIZHIRITSKAYA, EMILYA (MD)
Entity Type:Individual
Prefix:MRS
First Name:EMILYA
Middle Name:
Last Name:MIZHIRITSKAYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CORBIN PL APT L1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4932
Mailing Address - Country:US
Mailing Address - Phone:718-891-7750
Mailing Address - Fax:718-891-7829
Practice Address - Street 1:200 CORGIN PLACE #L1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235
Practice Address - Country:US
Practice Address - Phone:718-891-7750
Practice Address - Fax:718-891-7829
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180440103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01181864Medicaid
E40733Medicare UPIN
NY01181864Medicaid