Healthcare Provider Details

I. General information

NPI: 1588659783
Provider Name (Legal Business Name): TATYANA SARTAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N BROADWAY
IRVINGTON NY
10533-1254
US

IV. Provider business mailing address

3411 IRWIN AVE APT 19-D
BRONX NY
10463-3732
US

V. Phone/Fax

Practice location:
  • Phone: 914-591-7300
  • Fax:
Mailing address:
  • Phone: 718-432-1039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number221835
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: