Active NPI
Marina Yusupov
- Internal Medicine Physician
- Bronx, NY
National Provider Identifier
1649633090
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 313199
- Practice address
- 5750 Mosholu Ave
Bronx, NY 10471-2206 - Phone
- (718) 363-6771
- Fax
- (718) 363-6982
- NPI assigned
- Apr 2, 2016
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Internal Medicine Physician | 207R00000X | 313199 | NY | Primary |
Addresses
Primary practice location
5750 Mosholu Ave
Bronx, NY 10471-2206
Mailing address
103 Hog Hill Rd
Chappaqua, NY 10514-1114
Phone (212) 470-8221
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 313199 | NY | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1459555200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1685664000000",
"number": "1649633090",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "103 HOG HILL RD",
"city": "CHAPPAQUA",
"state": "NY",
"postal_code": "105141114",
"telephone_number": "212-470-8221"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5750 MOSHOLU AVE",
"city": "BRONX",
"state": "NY",
"postal_code": "104712206",
"telephone_number": "718-363-6771",
"fax_number": "718-363-6982"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YUSUPOV",
"first_name": "MARINA",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-04-02",
"last_updated": "2023-06-02",
"certification_date": "2023-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NY",
"license": "313199",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bronx, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.