Provider Demographics
NPI:1245265586
Name:KISINA, TATYANA (MD)
Entity type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:KISINA
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 1:2806 EAST 23 ST
Mailing Address - Street 2:#6A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235
Mailing Address - Country:US
Mailing Address - Phone:718-496-8755
Mailing Address - Fax:718-375-2735
Practice Address - Street 1:3065 BRIGHTON 14TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5545
Practice Address - Country:US
Practice Address - Phone:718-496-8755
Practice Address - Fax:718-375-2735
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223341-12081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2I3991Medicare ID - Type Unspecified
NYH63674Medicare UPIN