Provider Demographics
NPI:1467634253
Name:UVATOV PODIATRY PC
Entity Type:Organization
Organization Name:UVATOV PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:UVATOV
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-869-1098
Mailing Address - Street 1:145 HENRY PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-1359
Mailing Address - Country:US
Mailing Address - Phone:718-869-1098
Mailing Address - Fax:
Practice Address - Street 1:1468 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-1550
Practice Address - Country:US
Practice Address - Phone:917-817-8262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006193213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02940958Medicaid
NYWXTTZ1Medicare PIN
NY6075770001Medicare NSC