Healthcare Provider Details

I. General information

NPI: 1124000617
Provider Name (Legal Business Name): LYUDMILA A SIRENKO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139-12 84 DR
BRIARWOOD NY
11435
US

IV. Provider business mailing address

139-12 84 DR
BRIARWOOD NY
11435
US

V. Phone/Fax

Practice location:
  • Phone: 718-739-4969
  • Fax: 718-739-5041
Mailing address:
  • Phone: 718-739-4969
  • Fax: 718-739-5041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number047220
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: