Provider Demographics
NPI:1356730337
Name:LELYANOV, OLEKSIY (DO)
Entity type:Individual
Prefix:DR
First Name:OLEKSIY
Middle Name:
Last Name:LELYANOV
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 MIDDLETOWN BLVD
Mailing Address - Street 2:STE 201
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1817
Mailing Address - Country:US
Mailing Address - Phone:267-802-1002
Mailing Address - Fax:609-537-7301
Practice Address - Street 1:680 MIDDLETOWN BLVD
Practice Address - Street 2:STE 201
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1817
Practice Address - Country:US
Practice Address - Phone:267-802-1002
Practice Address - Fax:609-537-7301
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB10025600174400000X, 207L00000X, 207LP2900X
NJP14-00533390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No174400000XOther Service ProvidersSpecialist
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program