Provider Demographics
NPI:1770987984
Name:BURYEV, VILENA
Entity type:Individual
Prefix:
First Name:VILENA
Middle Name:
Last Name:BURYEV
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 1:6336 99TH ST
Mailing Address - Street 2:APT 4J
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1979
Mailing Address - Country:US
Mailing Address - Phone:718-899-9060
Mailing Address - Fax:718-899-9061
Practice Address - Street 1:6336 99TH ST
Practice Address - Street 2:APT 4J
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1979
Practice Address - Country:US
Practice Address - Phone:347-944-3719
Practice Address - Fax:718-899-9061
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program