Provider Demographics
NPI:1942272323
Name:LINETSKAYA, YELENA (MD DO)
Entity Type:Individual
Prefix:DR
First Name:YELENA
Middle Name:
Last Name:LINETSKAYA
Suffix:
Gender:F
Credentials:MD DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 GRAVESEND NECK RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4810
Mailing Address - Country:US
Mailing Address - Phone:718-769-9100
Mailing Address - Fax:718-769-7814
Practice Address - Street 1:2114 GRAVESEND NECK RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4810
Practice Address - Country:US
Practice Address - Phone:718-769-9100
Practice Address - Fax:718-769-7814
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2238681207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02219827Medicaid
H63153Medicare UPIN
NY02219827Medicaid