Provider Demographics
NPI:1922564186
Name:TERUSHKIN, YELENA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:YELENA
Middle Name:
Last Name:TERUSHKIN
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 COURT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-4091
Mailing Address - Country:US
Mailing Address - Phone:718-812-6879
Mailing Address - Fax:
Practice Address - Street 1:480 COURT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-4091
Practice Address - Country:US
Practice Address - Phone:347-830-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant