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NPI Code Detail

MEDICARE: TATIANA ZINCHUK

MEDICARE: TATIANA ZINCHUK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician210743NY
2208000000XPediatrics Physician036575CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
110450881OTHERCAQH

General Provider Information

NPI Number : 1093700619
Entity Type Code : Individual
Provider Name (Legal Business Name) : TATIANA ZINCHUK
Provider Business Mailing Address
First Line : 46 HOP BROOK RD
Second Line :
City : BROOKFIELD
State : CT
Zip : 06804-1326
Country : US
Telephone Number : 203-775-3810
Fax Number :
Provider Business Practice Location Address
First Line : 2800 MAIN ST
Second Line :
City : BRIDGEPORT
State : CT
Zip : 06606-4201
Country : US
Telephone Number : 203-576-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2005
Last Update Date : 02/29/2016

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Directions to “ TATIANA ZINCHUK ” Practice Location

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