Provider Demographics
NPI:1598898546
Name:YAKIREVICH, ELINA (PA)
Entity Type:Individual
Prefix:MRS
First Name:ELINA
Middle Name:
Last Name:YAKIREVICH
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 1:1201 OCEAN PKWY APT 6B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5158
Mailing Address - Country:US
Mailing Address - Phone:917-549-5395
Mailing Address - Fax:
Practice Address - Street 1:111 EAST 210TH STREET
Practice Address - Street 2:MONTEFIORE MEDICAL CENTER
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2490
Practice Address - Country:US
Practice Address - Phone:718-920-4385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008213363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant