Provider Demographics
NPI:1306109160
Name:TARAN, KSENIYA (MD)
Entity type:Individual
Prefix:MS
First Name:KSENIYA
Middle Name:
Last Name:TARAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:OKSANA
Other - Middle Name:
Other - Last Name:TARANOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAABASPED TEACHER
Mailing Address - Street 1:1270 E 19TH ST APT 4A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5412
Mailing Address - Country:US
Mailing Address - Phone:347-628-1665
Mailing Address - Fax:347-713-6683
Practice Address - Street 1:1270 E 19TH ST APT 4A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5412
Practice Address - Country:US
Practice Address - Phone:347-628-1665
Practice Address - Fax:347-713-6683
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY356620091174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist