MEDICARE: MS. TATYANA ARUMOVA OTA

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility	004271	NY

General Provider Information

NPI Number	:	1629278700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TATYANA ARUMOVA OTA

Provider Business Mailing Address
First Line	:	85 DIAMOND AVE
Second Line	:
City	:	EAST MEADOW
State	:	NY
Zip	:	11554-3402
Country	:	US
Telephone Number	:	516-520-3104
Fax Number	:

Provider Business Practice Location Address
First Line	:	85 DIAMOND AVE
Second Line	:
City	:	EAST MEADOW
State	:	NY
Zip	:	11554-3402
Country	:	US
Telephone Number	:	516-520-3104
Fax Number	:

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

Provider Enumeration Date	:	07/18/2007
Last Update Date	:	07/18/2007

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