Healthcare Provider Details

I. General information

NPI: 1467675280
Provider Name (Legal Business Name): TANYA VAYSMAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 E 87TH ST APT 1B
NEW YORK NY
10128-2701
US

IV. Provider business mailing address

129 E 61ST ST APT 6
NEW YORK NY
10021-8101
US

V. Phone/Fax

Practice location:
  • Phone: 212-360-0835
  • Fax:
Mailing address:
  • Phone: 212-360-0835
  • Fax: 212-360-0837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0508491
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: