MEDICARE: DR. TATYANA KATSMAN D.O.

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	MB073901	NJ
2	207Q00000X	Family Medicine Physician	291980	NY

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	291980	OTHER	NY	STATE LICENSE

General Provider Information

NPI Number	:	1447259841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TATYANA KATSMAN D.O.

Provider Business Mailing Address
First Line	:	2690 KENNEDY BLVD
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-5804
Country	:	US
Telephone Number	:	201-451-1601
Fax Number	:

Provider Business Practice Location Address
First Line	:	3974 AMBOY RD STE 302
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10308-2414
Country	:	US
Telephone Number	:	718-967-1071
Fax Number	:	888-908-8284

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

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	06/18/2019

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