Healthcare Provider Details

I. General information

NPI: 1649220369
Provider Name (Legal Business Name): ANYA KISHINEVSKY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

722 POST RD SUITE 200
DARIEN CT
06820-4731
US

IV. Provider business mailing address

78 OLIVE ST #315
NEW HAVEN CT
06511-6981
US

V. Phone/Fax

Practice location:
  • Phone: 203-656-9999
  • Fax: 203-655-0099
Mailing address:
  • Phone: 917-318-2823
  • Fax: 203-785-5714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number043761
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: