Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic | 007973-1 | NY |
NPI | 1710156351 |
---|---|
Provider Name | Yelena Isakbayeva |
First Address | Flushing, NY 11355 |
Second Address | Flushing, NY 11355-3934 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2008 |
Last Update Date | 28/02/2008 |