Provider Demographics
NPI:1366534992
Name:NOVOSELSKY, YELIZAVETA LVOVNA (MD PEDIATRICIAN)
Entity type:Individual
Prefix:
First Name:YELIZAVETA
Middle Name:LVOVNA
Last Name:NOVOSELSKY
Suffix:
Gender:F
Credentials:MD PEDIATRICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 E 76TH ST
Mailing Address - Street 2:APT C209
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2547
Mailing Address - Country:US
Mailing Address - Phone:212-744-0714
Mailing Address - Fax:
Practice Address - Street 1:370 E 76TH ST
Practice Address - Street 2:APT C209
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2547
Practice Address - Country:US
Practice Address - Phone:212-744-0714
Practice Address - Fax:212-744-0714
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2013-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169004208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY009913197Medicaid
D92104Medicare UPIN
NY62158AMedicare ID - Type Unspecified