Healthcare Provider Details

I. General information

NPI: 1568530848
Provider Name (Legal Business Name): TATYANA UVATOV
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2006
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1468 RICHMOND AVE
STATEN ISLAND NY
10314-1550
US

IV. Provider business mailing address

145 HENRY PL
STATEN ISLAND NY
10305-1359
US

V. Phone/Fax

Practice location:
  • Phone: 917-817-8262
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number006193
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: