MEDICARE: YELENA PERTSOVSKY D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	226560	NY

General Provider Information

NPI Number	:	1861489163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YELENA PERTSOVSKY D.O.

Provider Business Mailing Address
First Line	:	30 MONTGOMERY ST
Second Line	:	STE 720
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-3834
Country	:	US
Telephone Number	:	718-897-8356
Fax Number	:

Provider Business Practice Location Address
First Line	:	5901 PALISADE AVE
Second Line	:
City	:	RIVERDALE
State	:	NY
Zip	:	10471-1205
Country	:	US
Telephone Number	:	718-581-1200
Fax Number	:	718-581-1012

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2005
Last Update Date	:	04/21/2020

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