Provider Demographics
NPI:1417266602
Name:ELISHAIYEV, DIANA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:ELISHAIYEV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2620
Mailing Address - Country:US
Mailing Address - Phone:347-327-1141
Mailing Address - Fax:
Practice Address - Street 1:392B BEDFORD PARK BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-2415
Practice Address - Country:US
Practice Address - Phone:718-684-8864
Practice Address - Fax:718-684-8865
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0550501835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric