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NPI Code Detail

MEDICARE: TATSIANA POLONSKIY

MEDICARE:   TATSIANA  POLONSKIY
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
1174400000XSpecialist2388303NY

General Provider Information

NPI Number : 1982966339
Entity Type Code : Individual
Provider Name (Legal Business Name) : TATSIANA POLONSKIY
Provider Business Mailing Address
First Line : 1835 RICHMOND RD
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10306-2560
Country : US
Telephone Number : 917-407-8052
Fax Number : 718-701-1188
Provider Business Practice Location Address
First Line : 1835 RICHMOND RD
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10306-2560
Country : US
Telephone Number : 917-407-8052
Fax Number : 718-701-1188
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2012
Last Update Date : 06/12/2012

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Directions to “ TATSIANA POLONSKIY ” Practice Location

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