Provider Demographics
NPI:1851355531
Name:MAZURSKAYA, YELENA
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:MAZURSKAYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 14
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-9061
Mailing Address - Country:US
Mailing Address - Phone:718-257-0900
Mailing Address - Fax:718-257-5622
Practice Address - Street 1:1110 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 14
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-9061
Practice Address - Country:US
Practice Address - Phone:718-257-0900
Practice Address - Fax:718-257-5622
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227534207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02405443Medicaid
NY8216722001OtherCIGNA PPO
NYYM074V5210OtherELECTRONICAL MEDICARE
NY113414745OtherMAGNACARE
NY113414745Other1199
NY5C4528OtherHEALTHNET
NYP3656557OtherOXFORD
NY113414745OtherMULTIPLAN
NYMY7534OtherATLANTIS
NY113414745OtherCCM
NY113414745OtherUNITED HEALTHCARE
NY5995808OtherGHI PPO