Healthcare Provider Details

I. General information

NPI: 1003261801
Provider Name (Legal Business Name): DR. ALEXANDER K LYASHCHENKO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 MAGAW PL APT 24B
NEW YORK NY
10033-5275
US

IV. Provider business mailing address

8 MAGAW PL APT 24B
NEW YORK NY
10033-5275
US

V. Phone/Fax

Practice location:
  • Phone: 917-463-9183
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZC0006X
TaxonomyClinical Pathology Physician
License Number296963
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: