Individual
ANDREY TAKHTOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
555 SAINT JOSEPHS BLVD, ELMIRA, NY 14901-3223
(607) 795-8035
Mailing address
92 STONEHURST DR, TENAFLY, NJ 07670-2917
(201) 227-8598
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
302917
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/10/2018
Last updated
09/07/2021
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