Provider Demographics
NPI:1437251840
Name:TALYANSKY, LEONID
Entity Type:Individual
Prefix:MR
First Name:LEONID
Middle Name:
Last Name:TALYANSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 AVE. U
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229
Mailing Address - Country:US
Mailing Address - Phone:718-382-6409
Mailing Address - Fax:718-376-1422
Practice Address - Street 1:1212 AVENUE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4107
Practice Address - Country:US
Practice Address - Phone:718-382-6409
Practice Address - Fax:718-376-1422
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0858750001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0858750001Medicare NSC