Provider Demographics
NPI:1265668727
Name:YASHAYEV, ROMAN (PA)
Entity type:Individual
Prefix:
First Name:ROMAN
Middle Name:
Last Name:YASHAYEV
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1981 MARCUS AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1038
Mailing Address - Country:US
Mailing Address - Phone:631-670-1651
Mailing Address - Fax:516-437-4167
Practice Address - Street 1:5645 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5045
Practice Address - Country:US
Practice Address - Phone:718-670-2608
Practice Address - Fax:516-437-4167
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY012222363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant