Provider Demographics
NPI:1447351754
Name:SIONOV, ARTHUR
Entity type:Individual
Prefix:
First Name:ARTHUR
Middle Name:
Last Name:SIONOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2724 QUEENS PLZ S
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-4102
Mailing Address - Country:US
Mailing Address - Phone:718-482-7462
Mailing Address - Fax:718-482-7462
Practice Address - Street 1:2724 QUEENS PLZ S
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-4102
Practice Address - Country:US
Practice Address - Phone:718-482-7462
Practice Address - Fax:718-482-7462
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007688-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02501444Medicaid