Basic Information
| Provider Information | |||||||||
| NPI: | 1730144809 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHILIMOVA | ||||||||
| FirstName: | YELENA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1009 BRIGHTON BEACH AVE | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112355659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189758500 | ||||||||
| FaxNumber: | 7189758502 | ||||||||
| Practice Location | |||||||||
| Address1: | 1009 BRIGHTON BEACH AVE | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112355659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189758500 | ||||||||
| FaxNumber: | 7189758502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 02/22/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 204311 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 01867656 | 05 | NY | MEDICAID | 204311 | 01 | NY | LICENSE NUMBER | OTHER |