Individual
DR. IGOR TKACHUK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
475 SEAVIEW AVE, STATEN ISLAND, NY 10305-3436
(718) 226-9877
Mailing address
128 SAND LN, STATEN ISLAND, NY 10305-4543
(718) 273-5006
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
056964
NY
Other
Enumeration date
04/12/2012
Last updated
06/13/2017
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