Healthcare Provider Details

I. General information

NPI: 1518015049
Provider Name (Legal Business Name): ALEKSANDR LYAKHOVETSKIY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 E 149TH ST
BRONX NY
10451-5503
US

IV. Provider business mailing address

9602 4TH AVE APT 6M
BROOKLYN NY
11209-7822
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-5959
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number047766
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: