MEDICARE: NATALLIA V FIADORCHANKA M.D.

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
1	207N00000X	Dermatology Physician	281234	NY

General Provider Information

NPI Number	:	1215295480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALLIA V FIADORCHANKA M.D.

Provider Business Mailing Address
First Line	:	1938 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6513
Country	:	US
Telephone Number	:	718-905-5000
Fax Number	:	877-991-8177

Provider Business Practice Location Address
First Line	:	1938 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-6513
Country	:	US
Telephone Number	:	718-905-5000
Fax Number	:	877-991-8177

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2012
Last Update Date	:	10/31/2024

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