Provider Demographics
NPI:1861489163
Name:PERTSOVSKY, YELENA (DO)
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:PERTSOVSKY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MONTGOMERY ST
Mailing Address - Street 2:STE 720
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-3834
Mailing Address - Country:US
Mailing Address - Phone:718-897-8356
Mailing Address - Fax:
Practice Address - Street 1:5901 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:NY
Practice Address - Zip Code:10471-1205
Practice Address - Country:US
Practice Address - Phone:718-581-1200
Practice Address - Fax:718-581-1012
Is Sole Proprietor?:No
Enumeration Date:2005-10-02
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226560207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY492AU1Medicare PIN