Dateshidze, Konstantin
Dateshidze, Konstantin is an individual health care provider with primary practice located at 200 Trenton Rd , Browns Mills NJ 08015-1705. He recently has only one registered license in Allopathic & Osteopathic Physicians / Anesthesiology, which is considered as his primary health care specialty. Dateshidze, Konstantin can be contacted via phone (609) 893-1200.Contact Information
Primary practice address
200 Trenton Rd
Browns Mills NJ 08015-1705
Phone: (609) 893-1200
Fax: (609) 893-1213
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Allopathic & Osteopathic Physicians / Anesthesiology | 207L00000X | 25MA04546400 | New Jersey |
Profile Details
NPI number | 1104873827 |
---|---|
LBN Legal business name | Dateshidze, Konstantin |
Credentials | Doctor of Medicine (MD) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | May 28th, 2006 |
Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1104873827 | NPPES |
New Jersey | MEDICAID | 0917907 |
Popular Providers
-
Dominguez, William F.
1100 Central Ave Se , Albuquerque NM 87106-4930 -
Depper, Jane A.
1100 Central Ave Se , Albuquerque NM 87106-4930 -
Sheedy, Matthew Scott
200 Trenton Rd , Browns Mills NJ 08015-1705 -
Smith, Michael A
24 Stevens St , Norwalk CT 06850-3852 -
Tsyganov, Igor V
2401 Bay Ave , Ocean City NJ 08226-2456 -
Peck, Randall J
1 Taylor Ave , Pearisburg VA 24134-1932 -
Brooks, Jeffrey C
2900 Lamb Cir Ste 340, Christiansburg VA 24073-6344 -
Dickinson, William A
200 Hawkins Dr , Iowa City IA 52242-1009