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General NPI Number Information
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NPI Number | 1417266602
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Entity Type | Individual
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Provider Name | DIANA ELISHAIYEV
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Gender | Female
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Dates
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Enumeration Date | 10/05/2010
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Last Update Date | 11/10/2025
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Provider Practice Location Address
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Address Line | 392B BEDFORD PARK BLVD
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City | BRONX
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State | NY
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Zip | 10458-2415
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Country | US
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Telephone | 718-684-8864
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Fax | 718-684-8865
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Provider Business Mailing Address
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Address Line | 10 LINDEN ST
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City | WOODMERE
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State | NY
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Zip | 11598-2620
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Country | US
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Telephone | 347-327-1141
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835G0303X
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Taxonomy Name | Geriatric Pharmacist
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License Number | 055050
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License Number State | NY
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