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
Fax: (609) 893-1213
Website:

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1104873827 NPPES
New Jersey MEDICAID 0917907

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