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General NPI Number Information
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NPI Number | 1568530848
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Entity Type | Individual
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Provider Name | TATYANA UVATOV
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Gender | Female
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Dates
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Enumeration Date | 12/02/2006
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Last Update Date | 01/10/2017
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Provider Practice Location Address
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Address Line | 1468 RICHMOND AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10314-1550
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Country | US
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Telephone | 917-817-8262
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Fax |
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Provider Business Mailing Address
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Address Line | 145 HENRY PL
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City | STATEN ISLAND
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State | NY
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Zip | 10305-1359
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 006193
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License Number State | NY
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