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NPI Code Detail

MEDICARE: BELLA YUSHUVAYEV PA

MEDICARE: BELLA YUSHUVAYEV PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant013567NY

General Provider Information

NPI Number : 1467756841
Entity Type Code : Individual
Provider Name (Legal Business Name) : BELLA YUSHUVAYEV PA
Provider Business Mailing Address
First Line : 8340 WOODHAVEN BLVD
Second Line :
City : GLENDALE
State : NY
Zip : 11385-7824
Country : US
Telephone Number : 718-441-4444
Fax Number : 718-441-4487
Provider Business Practice Location Address
First Line : 8340 WOODHAVEN BLVD
Second Line :
City : GLENDALE
State : NY
Zip : 11385-7824
Country : US
Telephone Number : 718-441-4444
Fax Number : 718-441-4487
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2010
Last Update Date : 12/29/2010

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Directions to “ BELLA YUSHUVAYEV PA” Practice Location

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