Active NPI
Irina Yusupova
- Specialist
- Fresh Meadows, NY
National Provider Identifier
1649515636
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- Practice address
- 17911 69TH Ave
Fresh Meadows, NY 11365-3519 - Phone
- (718) 316-5676
- NPI assigned
- Dec 3, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | Primary |
Addresses
Primary practice location
17911 69TH Ave
Fresh Meadows, NY 11365-3519
Mailing address
179-11 69TH Ave
Fresh Meadows, NY 11365
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1354492800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1354492800000",
"number": "1649515636",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "179-11 69TH AVE",
"city": "FRESH MEADOWS",
"state": "NY",
"postal_code": "11365"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17911 69TH AVE",
"city": "FRESH MEADOWS",
"state": "NY",
"postal_code": "113653519",
"telephone_number": "718-316-5676"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YUSUPOVA",
"first_name": "IRINA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-12-03",
"last_updated": "2012-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresh Meadows, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.