Healthcare Provider Details

I. General information

NPI: 1508899626
Provider Name (Legal Business Name): YELENA KOROBKOVA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 11/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 MASSACHUSETTS AVE
TROY NY
12180-1628
US

IV. Provider business mailing address

10 COMMERCE DR
NEW ROCHELLE NY
10801-5214
US

V. Phone/Fax

Practice location:
  • Phone: 518-268-5000
  • Fax:
Mailing address:
  • Phone: 914-637-3510
  • Fax: 914-819-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number223816
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: