Healthcare Provider Details

I. General information

NPI: 1295274314
Provider Name (Legal Business Name): LINDENWOOD HEALTH MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2017
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3974 AMBOY RD SUITE 302
STATEN ISLAND NY
10308
US

IV. Provider business mailing address

3974 AMBOY RD SUITE 302
STATEN ISLAND NY
10308
US

V. Phone/Fax

Practice location:
  • Phone: 718-967-1071
  • Fax: 718-966-0359
Mailing address:
  • Phone: 718-967-1071
  • Fax: 718-966-0359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. TATYANA KATSMAN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 862-208-9959