Provider Demographics
NPI:1740999432
Name:ZULAK, TATIANA (LMT)
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:ZULAK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 PLEASANT VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5817
Mailing Address - Country:US
Mailing Address - Phone:978-935-1390
Mailing Address - Fax:
Practice Address - Street 1:184 PLEASANT VALLEY ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5817
Practice Address - Country:US
Practice Address - Phone:978-935-1390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17489-MT-MT175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath