Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 22DI02322000 | NJ |
Y | 213EG0000X | General Practice | 22DI02322000 | NJ |
NPI | 1003025503 |
---|---|
Provider Name | Dr. Svetlana Konstantinova |
First Address | Elizabeth, NJ 07201-2806 |
Second Address | Elizabeth, NJ 07201-2806 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 21/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0136051 | (05) | NJ |