Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 22D101916302 | NJ |
NPI | 1124179734 |
---|---|
Provider Name | Mr. Mikhail Zamikhovsky |
First Address | Watchung, NJ 07069 |
Second Address | Watchung, NJ 07069 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2007 |
Last Update Date | 08/07/2007 |