Physician Compare National (NPI:1508022666)

HEALTHCARE PROVIDER: NIKOLAY GATALYAK D.P.M.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1508022666
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	9739358268
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20110817000683
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GATALYAK
	Individual professional last name
Provider First Name	NIKOLAY
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	KENT STATE UNIVERSITY COLLEGE OF PODIATRIC MEDICINE
	Individual professional's medical school
Graduation Year	2008
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	125 CANTON RD NW
	Group Practice or individual's line 1 address
City	CARROLLTON
	Group Practice or individual's city
State	OH
	Group Practice or individual's state
Zip Code	446151009
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	360070
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	MERCY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y