MEDICARE: TATYANA UVATOV

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	213E00000X	Podiatrist	006193	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

General Provider Information

NPI Number	:	1568530848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TATYANA UVATOV

Provider Business Mailing Address
First Line	:	145 HENRY PL
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-1359
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1468 RICHMOND AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-1550
Country	:	US
Telephone Number	:	917-817-8262
Fax Number	:

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

Provider Enumeration Date	:	12/02/2006
Last Update Date	:	01/10/2017

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Directions to “ TATYANA UVATOV ” Practice Location

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