Provider Demographics
NPI:1417141532
Name:BEZOFF, ELENA (DO)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:
Last Name:BEZOFF
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3049 OCEAN PKWY FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-8395
Mailing Address - Country:US
Mailing Address - Phone:718-265-0005
Mailing Address - Fax:718-265-2410
Practice Address - Street 1:3049 OCEAN PKWY FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8395
Practice Address - Country:US
Practice Address - Phone:718-265-0005
Practice Address - Fax:718-265-2410
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250471207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease