Provider Demographics
NPI:1477646941
Name:POLISHCHUK, YELENA (NP)
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:POLISHCHUK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BERGEN REGIONAL MEDICAL CENTER
Mailing Address - Street 2:PO BOX 667
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07653-0667
Mailing Address - Country:US
Mailing Address - Phone:201-967-4000
Mailing Address - Fax:201-967-4205
Practice Address - Street 1:BERGEN REGIONAL MEDICAL CENTER
Practice Address - Street 2:230 E RIDGEWOOD AVE
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652
Practice Address - Country:US
Practice Address - Phone:201-967-4000
Practice Address - Fax:201-967-4205
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00057200363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ093221Medicare ID - Type UnspecifiedPROVIDER NUMBER
NJQ48845Medicare UPIN