Provider Demographics
NPI:1124485362
Name:YEGUTKIN, TATYANA
Entity type:Individual
Prefix:MRS
First Name:TATYANA
Middle Name:
Last Name:YEGUTKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 DAHILL RD
Mailing Address - Street 2:2 FL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-3573
Mailing Address - Country:US
Mailing Address - Phone:718-375-2505
Mailing Address - Fax:718-375-2472
Practice Address - Street 1:1580 DAHILL RD
Practice Address - Street 2:2 FL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-3573
Practice Address - Country:US
Practice Address - Phone:718-375-2505
Practice Address - Fax:718-375-2472
Is Sole Proprietor?:No
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator