Healthcare Provider Details

I. General information

NPI: 1780465757
Provider Name (Legal Business Name): MICHAL SIANOV PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 10/06/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 N TYSON AVE. SUITE 100
FLORAL PARK NY
11001
US

IV. Provider business mailing address

35 N TYSON AVE STE 100
FLORAL PARK NY
11001-1469
US

V. Phone/Fax

Practice location:
  • Phone: 718-276-7935
  • Fax:
Mailing address:
  • Phone: 718-276-7935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number030500-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: