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General NPI Number Information
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NPI Number | 1447259841
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Entity Type | Individual
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Provider Name | TATYANA KATSMAN D.O.
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Gender | Female
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 06/18/2019
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Provider Practice Location Address
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Address Line | 3974 AMBOY RD STE 302
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City | STATEN ISLAND
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State | NY
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Zip | 10308-2414
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Country | US
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Telephone | 718-967-1071
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Fax | 888-908-8284
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Provider Business Mailing Address
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Address Line | 2690 KENNEDY BLVD
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City | JERSEY CITY
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State | NJ
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Zip | 07306-5804
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Country | US
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Telephone | 201-451-1601
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MB073901
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 291980
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License Number State | NY
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