MEDICARE: DENIS GRATSIANSKIY

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	208600000X	Surgery Physician	ME161964	FL
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1659865541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENIS GRATSIANSKIY

Provider Business Mailing Address
First Line	:	2601 OCEAN PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-7745
Country	:	US
Telephone Number	:	718-616-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	5125 PALM SPRINGS BLVD UNIT 10309
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-5017
Country	:	US
Telephone Number	:	404-907-8182
Fax Number	:

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

Provider Enumeration Date	:	06/14/2018
Last Update Date	:	08/02/2024

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Directions to “ DENIS GRATSIANSKIY ” Practice Location

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