Healthcare Provider Details

I. General information

NPI: 1720116247
Provider Name (Legal Business Name): TATYANA GROYSMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

374 STOCKHOLM ST
BROOKLYN NY
11237-4006
US

IV. Provider business mailing address

1535 E 14TH ST APT 3H
BROOKLYN NY
11230-7190
US

V. Phone/Fax

Practice location:
  • Phone: 718-963-6485
  • Fax: 718-963-6793
Mailing address:
  • Phone: 718-710-8519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number271240
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: