Healthcare Provider Details

I. General information

NPI: 1639828965
Provider Name (Legal Business Name): YELIZAVET LOMAKOVA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 MOUNT HOPE AVE STE 250
ROCKAWAY NJ
07866-1657
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-6457
US

V. Phone/Fax

Practice location:
  • Phone: 973-891-3680
  • Fax: 973-895-2515
Mailing address:
  • Phone: 844-362-1735
  • Fax: 973-290-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MB13038300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: