Healthcare Provider Details

I. General information

NPI: 1316932015
Provider Name (Legal Business Name): SVETLANA B TEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2691 HYLAN BLVD SUITE D
STATEN ISLAND NY
10306-4357
US

IV. Provider business mailing address

77 WHITMAN AVE
STATEN ISLAND NY
10308-3226
US

V. Phone/Fax

Practice location:
  • Phone: 718-228-8500
  • Fax: 718-228-8500
Mailing address:
  • Phone: 718-228-8500
  • Fax: 718-228-8500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number239969
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: