Provider Demographics
NPI:1598920019
Name:KHAYSMAN, YELENA (MD)
Entity Type:Individual
Prefix:DR
First Name:YELENA
Middle Name:
Last Name:KHAYSMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-2214
Mailing Address - Country:US
Mailing Address - Phone:516-581-1216
Mailing Address - Fax:
Practice Address - Street 1:140 HEPBURN RD
Practice Address - Street 2:#11F
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-2231
Practice Address - Country:US
Practice Address - Phone:516-581-1216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY2546642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program