Healthcare Provider Details

I. General information

NPI: 1245265586
Provider Name (Legal Business Name): TATYANA KISINA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3065 BRIGHTON 14TH ST
BROOKLYN NY
11235-5545
US

IV. Provider business mailing address

2806 EAST 23 ST #6A
BROOKLYN NY
11235
US

V. Phone/Fax

Practice location:
  • Phone: 718-496-8755
  • Fax: 718-375-2735
Mailing address:
  • Phone: 718-496-8755
  • Fax: 718-375-2735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number223341-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: