Provider Demographics
NPI:1750474011
Name:ODULAK, TARAS J
Entity Type:Individual
Prefix:
First Name:TARAS
Middle Name:J
Last Name:ODULAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-8191
Mailing Address - Country:US
Mailing Address - Phone:212-260-2213
Mailing Address - Fax:
Practice Address - Street 1:33 E 7TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-8191
Practice Address - Country:US
Practice Address - Phone:212-260-2213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006018111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
X37421Medicare PIN
U18902Medicare UPIN