Yelena Kostyukov PA-C

NPI 1265720502 - Physician Assistant - 363A00000X

NPI Details
NPI 1265720502
Gender Female
Enumeration Date 07/20/2011
Last Updated 07/20/2011
Entity Type Individual
Active Over 5 years ago
Practice Location
30 MEDICAL CENTER BLVD
PROF OFFICE BLDG 1, SUITE 305
UPLAND PA, 19013, US
Phone (610) 874-4147
Fax
Business Location
535 BOBBIN MILL RD
MEDIA PA, 19063-1529, US
Phone
Fax
Toxanomy
Taxonomy Code 363A00000X
License State Pennsylvania
License Number MA054953
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According to our database, Yelena Kostyukov PA-C NPI is 1265720502, taxonomy code is 363A00000X and license number is MA054953, license state is located at Pennsylvania. Yelena Kostyukov PA-C physically located at 30 Medical Center Blvd, Upland PA, 19013. NPI Number Yelena Kostyukov PA-C has the Individual type.

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1265720502 NPI number is provided on an as is basis without warranty of any kind. 1265720502 is maintained by the National Plan & Provider Enumeration System. The contents of Yelena Kostyukov PA-C are for informational purposes only.