Provider Demographics
NPI:1457836645
Name:SIONOVA, MARINA
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:SIONOVA
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 1:253 W 72ND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2705
Mailing Address - Country:US
Mailing Address - Phone:212-769-1174
Mailing Address - Fax:212-769-1463
Practice Address - Street 1:253 W 72ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2705
Practice Address - Country:US
Practice Address - Phone:212-769-1174
Practice Address - Fax:212-769-1463
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00736-1156FX1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric Technician