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NPI Code Detail

MEDICARE: DR. YANINA KOSTINA M.D.

MEDICARE: DR. YANINA KOSTINA M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207W00000XOphthalmology Physician038708CT
2207WX0109XNeuro-ophthalmology Physician038708CT

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1180000891OTHERCTMEDICARE PTAN

General Provider Information

NPI Number : 1669442687
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. YANINA KOSTINA M.D.
Provider Business Mailing Address
First Line : 1201 W MAIN ST
Second Line : SUITE 100
City : WATERBURY
State : CT
Zip : 06708-3105
Country : US
Telephone Number : 203-597-9100
Fax Number : 203-401-6517
Provider Business Practice Location Address
First Line : 1201 W MAIN ST
Second Line : SUITE 100
City : WATERBURY
State : CT
Zip : 06708-3105
Country : US
Telephone Number : 203-597-9100
Fax Number : 203-596-4758
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2006
Last Update Date : 06/26/2024

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Directions to “ DR. YANINA KOSTINA M.D.” Practice Location

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