Provider Demographics
NPI:1326163080
Name:KARIKH, TATIANA DMITRIYEVNA (MD)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:DMITRIYEVNA
Last Name:KARIKH
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 1:106 COLUMBIA CT
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-5390
Mailing Address - Country:US
Mailing Address - Phone:212-215-6155
Mailing Address - Fax:212-684-0692
Practice Address - Street 1:304 PARK AVE S
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4301
Practice Address - Country:US
Practice Address - Phone:212-213-6155
Practice Address - Fax:212-684-0692
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214799-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY214799OtherLICENSE #
NYH13982Medicare UPIN