Provider Demographics
NPI:1063569457
Name:SISAKIAN, MARINA (MD)
Entity type:Individual
Prefix:DR
First Name:MARINA
Middle Name:
Last Name:SISAKIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARINA
Other - Middle Name:
Other - Last Name:SISAKIANMD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1385 YORK AVE
Mailing Address - Street 2:5E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3904
Mailing Address - Country:US
Mailing Address - Phone:646-339-3044
Mailing Address - Fax:
Practice Address - Street 1:1385 YORK AVE
Practice Address - Street 2:5E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3904
Practice Address - Country:US
Practice Address - Phone:646-339-3044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0024572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry