Provider Demographics
NPI:1184044927
Name:PRISTYAZHNYUK, YELENA
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:PRISTYAZHNYUK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 DINA CT
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-1185
Mailing Address - Country:US
Mailing Address - Phone:646-515-7630
Mailing Address - Fax:
Practice Address - Street 1:HHC CANCER INSTITUTE AT HARTFORD HOSPITAL
Practice Address - Street 2:85 RETREAT AVE
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2555
Practice Address - Country:US
Practice Address - Phone:860-249-6291
Practice Address - Fax:860-728-0151
Is Sole Proprietor?:No
Enumeration Date:2014-04-20
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT65171207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology