Healthcare Provider Details

I. General information

NPI: 1700886983
Provider Name (Legal Business Name): TATYANA R GITLEVICH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRADHURST AVE STE 3850
HAWTHORNE NY
10532-2199
US

IV. Provider business mailing address

19 BRADHURST AVE STE 3100N
HAWTHORNE NY
10532-2140
US

V. Phone/Fax

Practice location:
  • Phone: 914-345-1313
  • Fax: 913-345-5004
Mailing address:
  • Phone: 914-909-9018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084E0001X
TaxonomyEpilepsy Physician
License Number230302
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number230302
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: