MEDICARE: TATYANA FAST MD PC

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	207Q00000X	Family Medicine Physician

Other Identifiers

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

General Provider Information

NPI Number	:	1437898905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TATYANA FAST MD PC

Provider Business Mailing Address
First Line	:	160 WHITE RD STE 102
Second Line	:
City	:	LITTLE SILVER
State	:	NJ
Zip	:	07739-1167
Country	:	US
Telephone Number	:	732-450-0062
Fax Number	:	732-450-0616

Provider Business Practice Location Address
First Line	:	160 WHITE RD STE 102
Second Line	:
City	:	LITTLE SILVER
State	:	NJ
Zip	:	07739-1167
Country	:	US
Telephone Number	:	732-450-0062
Fax Number	:	732-450-0616

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TATYANA FAST
Credential	:	MD
Telephone Number	:	732-450-0062

Provider Enumeration Date	:	06/02/2022
Last Update Date	:	06/02/2022

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