Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204E00000X | Oral & Maxillofacial Surgeon | 25MA07315300 | NJ |
N | 208200000X | Surgeon | 25MA07315300 | NJ |
N | 208600000X | Surgeon | 25MA07315300 | NJ |
Y | 2082S0105X | Plastic Hand Surgeon | 25MA07315300 | NJ |
N | 2086S0105X | Surgery of the Hand | 25MA07315300 | NJ |
N | 2086S0122X | Plastic and Reconstructive Surgery | 25MA07315300 | NJ |
NPI | 1508930678 |
---|---|
Provider Name | Dr. David Z Evdokimow |
First Address | Basking Ridge, NJ 07920-1422 |
Second Address | Basking Ridge, NJ 07920-1422 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2006 |
Last Update Date | 07/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H49275 | (02) | NJ |