Healthcare Provider Details

I. General information

NPI: 1356730337
Provider Name (Legal Business Name): OLEKSIY LELYANOV D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2015
Last Update Date: 01/28/2022
Certification Date: 01/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 MIDDLETOWN BLVD STE 201
LANGHORNE PA
19047-1817
US

IV. Provider business mailing address

680 MIDDLETOWN BLVD STE 201
LANGHORNE PA
19047-1817
US

V. Phone/Fax

Practice location:
  • Phone: 267-802-1002
  • Fax: 609-537-7301
Mailing address:
  • Phone: 267-802-1002
  • Fax: 609-537-7301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberP14-00533
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MB10025600
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MB10025600
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number25MB10025600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: