Healthcare Provider Details

I. General information

NPI: 1194375238
Provider Name (Legal Business Name): TAMARA UZILOV RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1533 ROYCE ST APT 2D
BROOKLYN NY
11234-5881
US

IV. Provider business mailing address

1533 ROYCE ST APT 2D
BROOKLYN NY
11234-5881
US

V. Phone/Fax

Practice location:
  • Phone: 347-276-9871
  • Fax:
Mailing address:
  • Phone: 347-276-9871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86132326
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: