Provider Demographics
NPI:1568893766
Name:GUREVICH, TATIANA (MS SPED)
Entity Type:Individual
Prefix:MS
First Name:TATIANA
Middle Name:
Last Name:GUREVICH
Suffix:
Gender:F
Credentials:MS SPED
Other - Prefix:MS
Other - First Name:TATIANA
Other - Middle Name:
Other - Last Name:MALTSEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS SPED
Mailing Address - Street 1:1420 MEADOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-1955
Mailing Address - Country:US
Mailing Address - Phone:516-223-2021
Mailing Address - Fax:
Practice Address - Street 1:23 MARLOW RD
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-3705
Practice Address - Country:US
Practice Address - Phone:516-884-7742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-13
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency