Provider Demographics
NPI:1578647939
Name:DOBRUSKIN, YELIZAVETA (MD)
Entity Type:Individual
Prefix:DR
First Name:YELIZAVETA
Middle Name:
Last Name:DOBRUSKIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W MAIN ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2537
Mailing Address - Country:US
Mailing Address - Phone:732-761-1740
Mailing Address - Fax:732-761-8320
Practice Address - Street 1:901 W MAIN ST
Practice Address - Street 2:SUITE 104
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2537
Practice Address - Country:US
Practice Address - Phone:732-761-1740
Practice Address - Fax:732-761-8320
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08100700208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ074730Medicare PIN