Provider Demographics
NPI:1588177802
Name:YEZHOVA, ALIONA (PA)
Entity Type:Individual
Prefix:
First Name:ALIONA
Middle Name:
Last Name:YEZHOVA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 E TREMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-4363
Mailing Address - Country:US
Mailing Address - Phone:718-860-1111
Mailing Address - Fax:646-224-1320
Practice Address - Street 1:930 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-4363
Practice Address - Country:US
Practice Address - Phone:718-860-1111
Practice Address - Fax:646-224-1320
Is Sole Proprietor?:No
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0103631363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant