Healthcare Provider Details

I. General information

NPI: 1447259841
Provider Name (Legal Business Name): TATYANA KATSMAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3974 AMBOY RD STE 302
STATEN ISLAND NY
10308-2414
US

IV. Provider business mailing address

2690 KENNEDY BLVD
JERSEY CITY NJ
07306-5804
US

V. Phone/Fax

Practice location:
  • Phone: 718-967-1071
  • Fax: 888-908-8284
Mailing address:
  • Phone: 201-451-1601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMB073901
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number291980
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: