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NPI Code Detail

MEDICARE: DR. TATYANA ZIGADLO M.D.

MEDICARE: DR. TATYANA ZIGADLO 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
1207Q00000XFamily Medicine Physician25MA07494000NJ
2207Q00000XFamily Medicine Physician297712NY
3207Q00000XFamily Medicine PhysicianMD466581PA
4207Q00000XFamily Medicine PhysicianME139685FL
5207Q00000XFamily Medicine Physician277926MA
6207P00000XEmergency Medicine Physician25MA07494000NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1356349187
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TATYANA ZIGADLO M.D.
Provider Business Mailing Address
First Line : 600 HARBOR BLVD
Second Line :
City : WEEHAWKEN
State : NJ
Zip : 07086-6749
Country : US
Telephone Number : 917-650-1432
Fax Number :
Provider Business Practice Location Address
First Line : 308 WILLOW AVE
Second Line :
City : HOBOKEN
State : NJ
Zip : 07030-3808
Country : US
Telephone Number : 201-418-2065
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2005
Last Update Date : 10/22/2019

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