Provider Demographics
NPI:1356670913
Name:TATARSKAYA, TATYANA (ABOC)
Entity Type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:TATARSKAYA
Suffix:
Gender:F
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 NUGENT AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3500
Mailing Address - Country:US
Mailing Address - Phone:718-484-8410
Mailing Address - Fax:718-484-8413
Practice Address - Street 1:176 BRIGHTON 11TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5327
Practice Address - Country:US
Practice Address - Phone:718-484-8410
Practice Address - Fax:718-484-8413
Is Sole Proprietor?:No
Enumeration Date:2009-12-10
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007038156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician