Mondom, Tatjana

Mondom, Tatjana is an individual health care provider with primary practice located at 1656 Champlin Ave , Utica NY 13502-4830. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Mondom, Tatjana can be contacted via phone (315) 624-6467.

Contact Information

Primary practice address
1656 Champlin Ave Utica NY 13502-4830
Phone: (315) 624-6467
Fax: (315) 624-6469
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 227664-1 New York

Profile Details

NPI number 1851353148
LBN Legal business name Mondom, Tatjana
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 4th, 2006
Last updated Dec 7th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1851353148 NPPES
New York MEDICAID 02370285

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