Provider Demographics
NPI:1649220369
Name:KISHINEVSKY, ANYA (MD)
Entity Type:Individual
Prefix:
First Name:ANYA
Middle Name:
Last Name:KISHINEVSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 OLIVE ST
Mailing Address - Street 2:#315
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-6981
Mailing Address - Country:US
Mailing Address - Phone:917-318-2823
Mailing Address - Fax:203-785-5714
Practice Address - Street 1:722 POST RD
Practice Address - Street 2:SUITE 200
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4731
Practice Address - Country:US
Practice Address - Phone:203-656-9999
Practice Address - Fax:203-655-0099
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT043761208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery