Provider Demographics
NPI:1356638431
Name:GENIEVA, VITALIYA (DDS)
Entity Type:Individual
Prefix:
First Name:VITALIYA
Middle Name:
Last Name:GENIEVA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:VITALIYA
Other - Middle Name:
Other - Last Name:NECHYPORENKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:211 E 89TH ST
Mailing Address - Street 2:APT A5
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-4337
Mailing Address - Country:US
Mailing Address - Phone:644-630-1802
Mailing Address - Fax:
Practice Address - Street 1:211 E 89TH ST
Practice Address - Street 2:APT A5
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-4337
Practice Address - Country:US
Practice Address - Phone:644-630-1802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-08
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0387071223G0001X
NY055648-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice