MEDICARE: TATIANA DMITRIYEVNA KARIKH 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	174400000X	Specialist	214799-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	214799	OTHER	NY	LICENSE #

General Provider Information

NPI Number	:	1326163080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TATIANA DMITRIYEVNA KARIKH M.D.

Provider Business Mailing Address
First Line	:	106 COLUMBIA CT
Second Line	:
City	:	FREEHOLD
State	:	NJ
Zip	:	07728-5390
Country	:	US
Telephone Number	:	212-215-6155
Fax Number	:	212-684-0692

Provider Business Practice Location Address
First Line	:	304 PARK AVE S
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10010-4301
Country	:	US
Telephone Number	:	212-213-6155
Fax Number	:	212-684-0692

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/09/2007

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