Individual
TATYANA N. POLOVENKO-KALLMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
150 55TH ST, BROOKLYN, NY 11220-2559
(718) 630-7185
Mailing address
PO BOX 409041, ATLANTA, GA 30384-9041
(800) 377-8721
(304) 523-2241
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
002312
NY
207R00000X
Internal Medicine Physician
002312
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02654593
—
NY
01
—
299AG1
BCBS
NY
01
—
P00286376
RAILROAD
NY
Enumeration date
02/28/2006
Last updated
06/11/2021
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