Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 223341-1 | NY |
NPI | 1245265586 |
---|---|
Provider Name | Tatyana Kisina |
First Address | Brooklyn, NY 11235 |
Second Address | Brooklyn, NY 11235-5545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 07/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H63674 | (02) | NY |