Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086X0206X | Surgical Oncologist | 25MA09287900 | NJ |
NPI | 1376785360 |
---|---|
Provider Name | Vadim P Koshenkov |
First Address | New Brunswick, NJ 08901-1914 |
Second Address | New Brunswick, NJ 08901-1914 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2009 |
Last Update Date | 24/02/2014 |