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General NPI Number Information
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NPI Number | 1104419340
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Entity Type | Individual
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Provider Name | MRS. TATYANA DONSKOY
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Gender | Female
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Dates
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Enumeration Date | 02/18/2021
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Last Update Date | 02/18/2021
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Provider Practice Location Address
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Address Line | 5 MERIDIAN WAY
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City | SHREWSBURY
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State | NJ
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Zip | 07702-4353
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Country | US
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Telephone | 732-778-9785
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Fax |
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Provider Business Mailing Address
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Address Line | 48 PARK LN
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City | FAIR HAVEN
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State | NJ
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Zip | 07704-3516
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 40QB00299900
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License Number State | NJ
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