Healthcare Provider Details

I. General information

NPI: 1649458241
Provider Name (Legal Business Name): KONSTANTIN TARASHANSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 WOODBURY RD
HUNTINGTON NY
11743-4135
US

IV. Provider business mailing address

875 OLD COUNTRY RD SUITE 200
PLAINVIEW NY
11803-4966
US

V. Phone/Fax

Practice location:
  • Phone: 516-366-4141
  • Fax: 631-318-7680
Mailing address:
  • Phone: 516-931-5552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number235202
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: