Healthcare Provider Details

I. General information

NPI: 1154275097
Provider Name (Legal Business Name): EA PA HEALTH P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11909 AUDLEY ST
KEW GARDENS NY
11415-1342
US

IV. Provider business mailing address

11819 83RD AVE
KEW GARDENS NY
11415-1301
US

V. Phone/Fax

Practice location:
  • Phone: 212-380-6988
  • Fax:
Mailing address:
  • Phone: 212-380-6988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. EMANUEL AVEZBAKIYEV
Title or Position: FOUNDER
Credential: PHYSICIAN ASSISTANT
Phone: 212-380-6988