Provider Demographics
NPI:1184659203
Name:DESTIAN, SYLVIE (MD)
Entity Type:Individual
Prefix:DR
First Name:SYLVIE
Middle Name:
Last Name:DESTIAN
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 1:470 W 24TH ST
Mailing Address - Street 2:8G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-1205
Mailing Address - Country:US
Mailing Address - Phone:212-604-8748
Mailing Address - Fax:212-604-2929
Practice Address - Street 1:170 W 12TH ST
Practice Address - Street 2:LINK 217
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8202
Practice Address - Country:US
Practice Address - Phone:212-604-8748
Practice Address - Fax:212-604-2929
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1607332085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1977820Medicaid
NY1977820Medicaid
NY695921Medicare ID - Type Unspecified