Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 25MA09156500 | NJ |
NPI | 1033107669 |
---|---|
Provider Name | Boris Volshteyn |
First Address | West Long Branch, NJ 07764-1021 |
Second Address | West Long Branch, NJ 07764-1021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2005 |
Last Update Date | 27/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G86181 | (02) |