Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 25MB09948400 | NJ |
NPI | 1659682003 |
---|---|
Provider Name | Alexandra Kondratyeva |
First Address | New Brunswick, NJ 08901-1766 |
Second Address | New Brunswick, NJ 08901-1766 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2010 |
Last Update Date | 18/10/2016 |