Provider Demographics
NPI:1134255607
Name:YELSKAYA, LIDIYA (DDS)
Entity type:Individual
Prefix:
First Name:LIDIYA
Middle Name:
Last Name:YELSKAYA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 EMMONS AVE STE AA
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2771
Mailing Address - Country:US
Mailing Address - Phone:718-676-9500
Mailing Address - Fax:718-676-5120
Practice Address - Street 1:1625 EMMONS AVE STE AA
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2771
Practice Address - Country:US
Practice Address - Phone:718-676-9500
Practice Address - Fax:718-676-5120
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050051122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02289238Medicaid