Provider Demographics
NPI:1477506301
Name:ZASLAVSKY, TATIANA (DO)
Entity type:Individual
Prefix:MS
First Name:TATIANA
Middle Name:
Last Name:ZASLAVSKY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 EDGEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-4231
Mailing Address - Country:US
Mailing Address - Phone:201-969-0240
Mailing Address - Fax:
Practice Address - Street 1:3871 SEDGWICK AVE APT 1B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4433
Practice Address - Country:US
Practice Address - Phone:718-432-1440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221451207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02218660Medicaid
NY02218660Medicaid
NYH54110Medicare UPIN