Healthcare Provider Details

I. General information

NPI: 1467382358
Provider Name (Legal Business Name): ELIANA KOYENOVA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7508 172ND ST
FRESH MEADOWS NY
11366-1423
US

IV. Provider business mailing address

7508 172ND ST
FRESH MEADOWS NY
11366-1423
US

V. Phone/Fax

Practice location:
  • Phone: 917-509-7944
  • Fax: 917-509-7944
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: