Provider Demographics
NPI:1396177796
Name:SIANOV, LENA
Entity Type:Individual
Prefix:MS
First Name:LENA
Middle Name:
Last Name:SIANOV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6913 185TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3513
Mailing Address - Country:US
Mailing Address - Phone:347-288-2664
Mailing Address - Fax:
Practice Address - Street 1:6913 185TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-3513
Practice Address - Country:US
Practice Address - Phone:347-288-2664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1756430174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist