Dateshidze, Konstantin
Dateshidze, Konstantin is an individual health care provider with primary practice located at 200 Trenton Rd , Browns Mills NJ 08015-1705. He recently has only one registered license in Allopathic & Osteopathic Physicians / Anesthesiology, which is considered as his primary health care specialty. Dateshidze, Konstantin can be contacted via phone (609) 893-1200.Contact Information
Primary practice address
200 Trenton Rd
Browns Mills NJ 08015-1705
Phone: (609) 893-1200
Fax: (609) 893-1213
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Anesthesiology | 207L00000X | 25MA04546400 | New Jersey |
Profile Details
| NPI number | 1104873827 |
|---|---|
| LBN Legal business name | Dateshidze, Konstantin |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 28th, 2006 |
| Last updated | Jul 8th, 2007 - about 19 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1104873827 | NPPES |
| New Jersey | MEDICAID | 0917907 |
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