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General NPI Number Information
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NPI Number | 1912057787
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Entity Type | Individual
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Provider Name | TATYANA IRININA DPT
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Gender | Female
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 03/19/2012
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Provider Practice Location Address
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Address Line | 520 BLOOMINGDALE RD
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City | STATEN ISLAND
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State | NY
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Zip | 10309-2061
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Country | US
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Telephone | 718-605-1300
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Fax | 718-615-8739
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Provider Business Mailing Address
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Address Line | 19 EDISON ST
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City | STATEN ISLAND
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State | NY
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Zip | 10306-3410
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Country | US
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Telephone | 917-977-1067
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 023912
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License Number State | NY
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