Provider Demographics
NPI:1518948397
Name:JIGOULSKAIA, ELENA (RD)
Entity Type:Individual
Prefix:MS
First Name:ELENA
Middle Name:
Last Name:JIGOULSKAIA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 AVENUE Z
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5105
Mailing Address - Country:US
Mailing Address - Phone:718-934-9508
Mailing Address - Fax:815-550-1939
Practice Address - Street 1:1021 AVENUE Z
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5105
Practice Address - Country:US
Practice Address - Phone:718-934-9508
Practice Address - Fax:815-550-1939
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005832133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY8099763OtherGHI
NYP3577141OtherOXFORD HEALTH PLANS
NY9376380OtherPHCS
NY2409316OtherUNITEDHEALTHCARE
NY113621037OtherHORIZON HEALTH CARE
NY178651POtherHIP HEALTH PLAN
NY2409316OtherUNITEDHEALTHCARE