Provider Demographics
NPI:1184657967
Name:LEDOVSKY, TATYANA M (MD)
Entity Type:Individual
Prefix:
First Name:TATYANA
Middle Name:M
Last Name:LEDOVSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6415 FRESH POND RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-3330
Mailing Address - Country:US
Mailing Address - Phone:718-381-9500
Mailing Address - Fax:718-381-9505
Practice Address - Street 1:6415 FRESH POND RD
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-3330
Practice Address - Country:US
Practice Address - Phone:718-381-9500
Practice Address - Fax:718-381-9505
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214455208000000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01980065Medicaid
NY55330TNMedicare PIN
NY0026YLMedicare PIN
NYH29679Medicare UPIN