Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 214455 | NY |
N | 2080P0204X | Pediatric Emergency Doctor | 214455 | NY |
NPI | 1184657967 |
---|---|
Provider Name | Tatyana M. Ledovsky |
First Address | Ridgewood, NY 11385-3330 |
Second Address | Ridgewood, NY 11385-3330 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2006 |
Last Update Date | 18/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01980065 | (05) | NY |
H29679 | (02) | NY |