Basic Information
| Provider Information | |||||||||
| NPI: | 1356730337 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LELYANOV | ||||||||
| FirstName: | OLEKSIY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 680 MIDDLETOWN BLVD | ||||||||
| Address2: | STE 201 | ||||||||
| City: | LANGHORNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190471817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2678021002 | ||||||||
| FaxNumber: | 6095377301 | ||||||||
| Practice Location | |||||||||
| Address1: | 680 MIDDLETOWN BLVD | ||||||||
| Address2: | STE 201 | ||||||||
| City: | LANGHORNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190471817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2678021002 | ||||||||
| FaxNumber: | 6095377301 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2015 | ||||||||
| LastUpdateDate: | 01/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 25MB10025600 | NJ | N | Other Service Providers | Specialist | 207L00000X | 25MB10025600 | NJ | N | Allopathic & Osteopathic Physicians | Anesthesiology | 390200000X | P14-00533 | NJ | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207LP2900X | 25MB10025600 | NJ | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.