Provider Demographics
NPI:1588418594
Name:MARTYNOV, KIRILL
Entity type:Individual
Prefix:
First Name:KIRILL
Middle Name:
Last Name:MARTYNOV
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 1:44 BROOKDALE DR
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-2606
Mailing Address - Country:US
Mailing Address - Phone:646-243-9458
Mailing Address - Fax:
Practice Address - Street 1:44 BROOKDALE DR
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-2606
Practice Address - Country:US
Practice Address - Phone:646-243-9458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health