MEDICARE: DR. MARINA SISAKIAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	002457	NY

General Provider Information

NPI Number	:	1063569457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARINA SISAKIAN MD

Provider Business Mailing Address
First Line	:	1385 YORK AVE
Second Line	:	5E
City	:	NEW YORK
State	:	NY
Zip	:	10021-3904
Country	:	US
Telephone Number	:	646-339-3044
Fax Number	:

Provider Business Practice Location Address
First Line	:	1385 YORK AVE
Second Line	:	5E
City	:	NEW YORK
State	:	NY
Zip	:	10021-3904
Country	:	US
Telephone Number	:	646-339-3044
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	07/08/2007

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