Healthcare Provider Details

I. General information

NPI: 1053251256
Provider Name (Legal Business Name): ELINA GAZARYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6220 BAY PKWY APT E1
BROOKLYN NY
11204-3113
US

IV. Provider business mailing address

6220 BAY PKWY APT E1
BROOKLYN NY
11204-3113
US

V. Phone/Fax

Practice location:
  • Phone: 347-224-4183
  • Fax:
Mailing address:
  • Phone: 347-224-4183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberCERTIFIED
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: