Individual
DR. DMITRY LISENENKOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
475 SEAVIEW AVE, CARDIOTHORACIC ICU, STATEN ISLAND, NY 10305
(718) 775-7770
Mailing address
475 SEAVIEW AVE, STATEN ISLAND, NY 10305-3436
(718) 775-7770
Taxonomy
Speciality
Code
Description
License number
State
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
Primary
25MA11111600
NJ
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
249407
NY
Other
Enumeration date
07/07/2008
Last updated
05/02/2024
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