Individual
TARAS PETSYUKH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
357 ONDERDONK AVE # 2L, RIDGEWOOD, NY 11385-1334
(347) 243-2316
Mailing address
357 ONDERDONK AVE # 2L, RIDGEWOOD, NY 11385-1334
(347) 243-2316
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
Primary
670200
NY
Other
Enumeration date
10/17/2013
Last updated
10/17/2013
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