Provider Demographics
NPI:1275566564
Name:TSVENIASHVILI, LIA (MD,)
Entity Type:Individual
Prefix:
First Name:LIA
Middle Name:
Last Name:TSVENIASHVILI
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:PO BOX 95000-2240
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-2240
Mailing Address - Country:US
Mailing Address - Phone:212-523-6500
Mailing Address - Fax:212-523-7182
Practice Address - Street 1:1000 10TH AVE
Practice Address - Street 2:ST. LUKE'S ROOSEVELT HOSPITAL CENTER, SUITE 2T
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1147
Practice Address - Country:US
Practice Address - Phone:212-523-6500
Practice Address - Fax:212-523-7182
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223246207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02705457Medicaid
NYI20335Medicare UPIN
NY251AM1Medicare ID - Type Unspecified