Provider Demographics
NPI:1669411633
Name:AZRIELI, YEVGENY (MD)
Entity type:Individual
Prefix:DR
First Name:YEVGENY
Middle Name:
Last Name:AZRIELI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 W END AVE
Mailing Address - Street 2:APT 2C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-4919
Mailing Address - Country:US
Mailing Address - Phone:212-523-3652
Mailing Address - Fax:
Practice Address - Street 1:1090 AMSTERDAM AVE
Practice Address - Street 2:SUITE 5F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1737
Practice Address - Country:US
Practice Address - Phone:212-523-3652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2089802084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02172172Medicaid
NY02172172Medicaid
NYWEW131Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER
NY374N01Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE