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NPI Code Detail

MEDICARE: DR. ANRI ARONOVITCH KISSILENKO M.D.

MEDICARE:  DR. ANRI ARONOVITCH KISSILENKO  M.D.
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
12084P0800XPsychiatry Physician204449NY
22084P0800XPsychiatry Physician036852CT
32084P0805XGeriatric Psychiatry Physician204449NY
42084P0805XGeriatric Psychiatry Physician036852CT

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1260041014OTHERGARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2618725OTHERTRIGON BCBS

General Provider Information

NPI Number : 1669569216
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANRI ARONOVITCH KISSILENKO M.D.
Provider Business Mailing Address
First Line : 12 QUINCY LN
Second Line :
City : WHITE PLAINS
State : NY
Zip : 10605-5430
Country : US
Telephone Number : 914-946-9525
Fax Number :
Provider Business Practice Location Address
First Line : 208 VALLEY RD
Second Line :
City : NEW CANAAN
State : CT
Zip : 06840-3812
Country : US
Telephone Number : 203-801-2235
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2006
Last Update Date : 09/07/2016

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