Individual
DR. TARAS VYSOTSKYY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
45 RICHMOND BLVD, UNIT 2A, RONKONKOMA, NY 11779-3622
(516) 695-0112
Mailing address
45 RICHMOND BLVD, UNIT 2A, RONKONKOMA, NY 11779-3622
(516) 695-0112
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
005677
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005677
—
NY
Enumeration date
08/01/2014
Last updated
04/17/2017
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