1245275320 NPI number — SERGE KIANOVSKI D.P.T.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245275320 NPI number — SERGE KIANOVSKI D.P.T.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

KIANOVSKI

Provider First Name:

SERGE

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

D.P.T.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

KIYANOVSKIY

Provider Other First Name:

SERGEY

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

D.P.T.

Provider Other Last Name Type Code:

1

NPI Number:

1245275320

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/08/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

7803 20TH AVE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

BROOKLYN

Provider Business Mailing Address State Name:

NY

Provider Business Mailing Address Postal Code:

11214-1207

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

718-232-7778

Provider Business Mailing Address Fax Number:

718-232-9634

Provider First Line Business Practice Location Address:

7803 20TH AVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

BROOKLYN

Provider Business Practice Location Address State Name:

NY

Provider Business Practice Location Address Postal Code:

11214-1207

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

718-232-7778

Provider Business Practice Location Address Fax Number:

718-232-9634

Provider Enumeration Date:

06/20/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 225100000X , with the licence number:  016388 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
• Taxonomy code: 2251E1300X , with the licence number: 016388 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

• Identifier: 016388 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 02012040 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: P2459083 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 3C6820 . This is a "HEALTH NET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 833574 . This is a "EMPIRE PLAN (MPN)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 11081573 . This is a "MULTIPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 6698961 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: BK0224704 . This is a "AMERICHOICE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: QC2011 . This is a "EMPIRE BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 136981 . This is a "CHN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 177236 . This is a "ELDER PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".