Provider Demographics
NPI:1134762024
Name:KREYCHMAN, TATIANA
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:KREYCHMAN
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 1:2750 E 12TH ST APT 5F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4664
Mailing Address - Country:US
Mailing Address - Phone:718-974-5005
Mailing Address - Fax:
Practice Address - Street 1:2750 E 12TH ST APT 5F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-4664
Practice Address - Country:US
Practice Address - Phone:718-974-5005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1361189191174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty