Provider Demographics
NPI:1649458241
Name:TARASHANSKY, KONSTANTIN (MD)
Entity type:Individual
Prefix:DR
First Name:KONSTANTIN
Middle Name:
Last Name:TARASHANSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-4966
Mailing Address - Country:US
Mailing Address - Phone:516-931-5552
Mailing Address - Fax:
Practice Address - Street 1:107 WOODBURY RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4135
Practice Address - Country:US
Practice Address - Phone:516-366-4141
Practice Address - Fax:631-318-7680
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235202207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400017645Medicare PIN