Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204E00000X | Oral & Maxillofacial Surgeon | 057086 | NY |
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | 285541 | NY |
NPI | 1982991485 |
---|---|
Provider Name | Dr. Steve Yusupov |
First Address | Staten Island, NY 10305-1851 |
Second Address | Staten Island, NY 10305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2011 |
Last Update Date | 19/11/2019 |