Provider Demographics
NPI:1558507178
Name:TSENOVOY, PETR LEONIDOVICH (MD)
Entity Type:Individual
Prefix:
First Name:PETR
Middle Name:LEONIDOVICH
Last Name:TSENOVOY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 GRASSLANDS RD
Mailing Address - Street 2:NEW YORK MED COLLEGE, MUNGER PAVILION, ROOM 253
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1652
Mailing Address - Country:US
Mailing Address - Phone:914-493-8373
Mailing Address - Fax:
Practice Address - Street 1:19 MOHAWK AVE
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07648-2410
Practice Address - Country:US
Practice Address - Phone:201-392-3588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-02
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09126700208M00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty