Healthcare Provider Details

I. General information

NPI: 1659718047
Provider Name (Legal Business Name): ALEKSEY MARYANSKY D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2013
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 SEAVIEW AVE
STATEN ISLAND NY
10305-3436
US

IV. Provider business mailing address

BOX 5-24
NEW YORK NY
10087-5024
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-9292
  • Fax: 718-226-8142
Mailing address:
  • Phone: 800-627-4470
  • Fax: 412-937-5710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number292839
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: