Provider Demographics
NPI:1467461665
Name:AVERBUKH, YELENA (MD)
Entity Type:Individual
Prefix:DR
First Name:YELENA
Middle Name:
Last Name:AVERBUKH
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 1:111 E 210TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 E 210TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2401
Practice Address - Country:US
Practice Address - Phone:718-920-7270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227782207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY112735566OtherPHCS
NYAY7782OtherATLANTIS
NY227782OtherHIP
NY2321544OtherUNITED HEALTHCARE
NY233AHOtherB/C B/S
NY2591347OtherG.H.I.
NY9532092OtherCIGNA HEALTH PLAN
NY3233202OtherAETNA USHC HMO
NY112735566Other1199 NATIONAL HEALTH PLAN
NY7014462OtherAETNA USHC PPO
NY3C5345OtherPHS
NYP2914186OtherOXFORD HEALTH PLANS
NYAY7782OtherATLANTIS
NYH99395Medicare UPIN