Provider Demographics
NPI:1164598561
Name:LYAKHOVETSKAYA, LITA (MD)
Entity Type:Individual
Prefix:DR
First Name:LITA
Middle Name:
Last Name:LYAKHOVETSKAYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CLOVER HILL DR
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-1601
Mailing Address - Country:US
Mailing Address - Phone:203-357-9194
Mailing Address - Fax:
Practice Address - Street 1:420 NORTH AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-4160
Practice Address - Country:US
Practice Address - Phone:914-633-8842
Practice Address - Fax:914-633-8947
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2109332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH29650Medicare UPIN