Provider Demographics
NPI:1558575514
Name:VOITOVITCH-KHURGIN, TATIANA (DO)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:VOITOVITCH-KHURGIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 W 87TH ST
Mailing Address - Street 2:APT. 5C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-2904
Mailing Address - Country:US
Mailing Address - Phone:212-362-8295
Mailing Address - Fax:212-496-1621
Practice Address - Street 1:68-80 SCHERMERHORN ST.
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:718-858-7200
Practice Address - Fax:718-858-1119
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216515207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02092322Medicaid
NY216515OtherLICENSE
NY216515OtherLICENSE
NYH20247Medicare UPIN
NY216515OtherLICENSE