Provider Demographics
NPI:1093002339
Name:YUSHUVAYEV, ELINA (MD)
Entity Type:Individual
Prefix:
First Name:ELINA
Middle Name:
Last Name:YUSHUVAYEV
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 1:22215 NORTHERN BLVD LBBY A
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3603
Mailing Address - Country:US
Mailing Address - Phone:718-215-0020
Mailing Address - Fax:616-226-4785
Practice Address - Street 1:22215 NORTHERN BLVD LBBY A
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3603
Practice Address - Country:US
Practice Address - Phone:718-215-0020
Practice Address - Fax:616-226-4785
Is Sole Proprietor?:No
Enumeration Date:2011-07-07
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288432207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine