Provider Demographics
NPI:1861571143
Name:ZHARKOVSKY, TATYANA (RDMS)
Entity type:Individual
Prefix:
First Name:TATYANA
Middle Name:
Last Name:ZHARKOVSKY
Suffix:
Gender:F
Credentials:RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 FERNDALE RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-1927
Mailing Address - Country:US
Mailing Address - Phone:914-723-6802
Mailing Address - Fax:914-723-6802
Practice Address - Street 1:955 YONKERS AVE
Practice Address - Street 2:2 FLOOR
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-3060
Practice Address - Country:US
Practice Address - Phone:914-262-0004
Practice Address - Fax:914-723-6802
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000994-1133NN1002X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9307E1Medicare ID - Type Unspecified