Provider Demographics
NPI:1023053709
Name:ANYA KISHINEVSKY MD LLC
Entity type:Organization
Organization Name:ANYA KISHINEVSKY MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KISHINEVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-318-2823
Mailing Address - Street 1:722 POST RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-4731
Mailing Address - Country:US
Mailing Address - Phone:203-656-9999
Mailing Address - Fax:203-655-0099
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043761208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty