Healthcare Provider Details

I. General information

NPI: 1467634253
Provider Name (Legal Business Name): UVATOV PODIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2007
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: 718-869-1098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number006193
License Number StateNY

VIII. Authorized Official

Name: TATYANA UVATOV
Title or Position: PODIATRIST
Credential: DPM
Phone: 718-869-1098