Provider Demographics
NPI:1588659783
Name:SARTAN, TATYANA (MD)
Entity Type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:SARTAN
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 1:3411 IRWIN AVE
Mailing Address - Street 2:APT 19-D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3732
Mailing Address - Country:US
Mailing Address - Phone:718-432-1039
Mailing Address - Fax:
Practice Address - Street 1:100 N BROADWAY
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NY
Practice Address - Zip Code:10533-1254
Practice Address - Country:US
Practice Address - Phone:914-591-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221835208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02198745Medicaid