| Tatyana Semenova Physician P.c. | |
|
626 Sheepshead Bay Rd Ste 530 Brooklyn NY 11224-3606 | |
| (347) 277-9084 | |
| Not Available |
| Full Name | Tatyana Semenova Physician P.c. |
|---|---|
| Speciality | Clinic/Center |
| Location | 626 Sheepshead Bay Rd Ste 530, Brooklyn, New York |
| Authorized Official Name and Position | Tatyana Semenova (PRESIDENT) |
| Authorized Official Contact | 3472779084 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tatyana Semenova Physician P.c. 2258 84th St Brooklyn NY 11214-3383 Ph: (347) 277-9084 | Tatyana Semenova Physician P.c. 626 Sheepshead Bay Rd Ste 530 Brooklyn NY 11224-3606 Ph: (347) 277-9084 |
| NPI Number | 1790397891 |
|---|---|
| Provider Enumeration Date | 08/19/2020 |
| Last Update Date | 08/19/2020 |
| Certification Date | 08/19/2020 |
| Medicare PECOS PAC ID | 2466864657 |
|---|---|
| Medicare Enrollment ID | O20201211001136 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790397891 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Tatyana Semenova |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437431269 PECOS PAC ID: 0345411948 Enrollment ID: I20110912000079 |
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