Healthcare Provider Details

I. General information

NPI: 1649184722
Provider Name (Legal Business Name): ELENA IVANINA DO AND LESLEY MICHAEL DO PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W 57TH ST STE 407
NEW YORK NY
10019-3147
US

IV. Provider business mailing address

315 W 57TH ST STE 407
NEW YORK NY
10019-3147
US

V. Phone/Fax

Practice location:
  • Phone: 917-341-5326
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: LESLEY MICHAEL
Title or Position: OWNER
Credential: DO
Phone: 929-249-2359