Provider Demographics
NPI:1023357159
Name:TATYANA YUZBASHYAN MD PC
Entity Type:Organization
Organization Name:TATYANA YUZBASHYAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:YUZBASHYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-520-5498
Mailing Address - Street 1:50-10 44TH STREET
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377
Mailing Address - Country:US
Mailing Address - Phone:718-275-5200
Mailing Address - Fax:718-275-6864
Practice Address - Street 1:97-01 66TH AVE.
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374
Practice Address - Country:US
Practice Address - Phone:718-275-5200
Practice Address - Fax:718-275-6864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-08
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2581272084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty