Provider Demographics
NPI:1396616843
Name:STRYZHYEVSKYI, TYMUR
Entity type:Individual
Prefix:
First Name:TYMUR
Middle Name:
Last Name:STRYZHYEVSKYI
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 1:437 MANHATTAN ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10307-1810
Mailing Address - Country:US
Mailing Address - Phone:646-643-1167
Mailing Address - Fax:
Practice Address - Street 1:437 MANHATTAN ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10307-1810
Practice Address - Country:US
Practice Address - Phone:646-643-1167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCERTIFIED174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist