Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 0454141 | NY |
NPI | 1003888686 |
---|---|
Provider Name | Dr. Tatiana Korol |
First Address | Brooklyn, NY 11235 |
Second Address | Brooklyn, NY 11235 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 08/07/2007 |