Provider Demographics
NPI:1275506974
Name:TSIPURSKY, TATYANA P (MD)
Entity Type:Individual
Prefix:
First Name:TATYANA
Middle Name:P
Last Name:TSIPURSKY
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 1:753 PARK LN
Mailing Address - Street 2:
Mailing Address - City:NORTH WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3640
Mailing Address - Country:US
Mailing Address - Phone:718-616-5437
Mailing Address - Fax:718-336-1766
Practice Address - Street 1:2580 OCEAN PKWY
Practice Address - Street 2:SUITE L1D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7746
Practice Address - Country:US
Practice Address - Phone:718-336-1366
Practice Address - Fax:718-336-1766
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-12
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2118462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01971764Medicaid
NYG88014Medicare UPIN
NY01971764Medicaid