MEDICARE: TANYA KONTOROVICH OD

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
1	152W00000X	Optometrist	005351	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780781641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANYA KONTOROVICH OD

Provider Business Mailing Address
First Line	:	739 OCEAN PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-1113
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	739 OCEAN PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-1113
Country	:	US
Telephone Number	:	718-434-0881
Fax Number	:	718-859-6372

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	06/04/2008

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