Provider Demographics
NPI:1114104080
Name:DENYSOVA, MARYNA (RPA-C)
Entity Type:Individual
Prefix:
First Name:MARYNA
Middle Name:
Last Name:DENYSOVA
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8893 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-6008
Mailing Address - Country:US
Mailing Address - Phone:917-353-8757
Mailing Address - Fax:
Practice Address - Street 1:3201 KINGHS HIGHWAY
Practice Address - Street 2:KINGHS HIGHWAY DIVISION BETH ISRAEL MEDICAL CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234
Practice Address - Country:US
Practice Address - Phone:718-951-2901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011775363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400014323Medicare PIN