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General NPI Number Information
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NPI Number | 1184657967
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Entity Type | Individual
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Provider Name | TATYANA M. LEDOVSKY M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 04/18/2011
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Provider Practice Location Address
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Address Line | 6415 FRESH POND RD
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City | RIDGEWOOD
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State | NY
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Zip | 11385-3330
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Country | US
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Telephone | 718-381-9500
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Fax | 718-381-9505
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Provider Business Mailing Address
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Address Line | 6415 FRESH POND RD
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City | RIDGEWOOD
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State | NY
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Zip | 11385-3330
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Country | US
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Telephone | 718-381-9500
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Fax | 718-381-9505
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 214455
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number | 214455
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License Number State | NY
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