Datiashvili, Ramazi Otarovich

Datiashvili, Ramazi Otarovich is an individual health care provider with primary practice located at 90 Bergen St Doc 7200, Newark NJ 07103-2425. He recently has only one registered license in Allopathic & Osteopathic Physicians / Plastic and Reconstructive Surgery, which is considered as his primary health care specialty. Datiashvili, Ramazi Otarovich can be contacted via phone (973) 972-1129.

Contact Information

Primary practice address
90 Bergen St Doc 7200 Newark NJ 07103-2425
Phone: (973) 972-1129
Fax: (973) 972-2407
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Plastic and Reconstructive Surgery 2086S0122X 25MA06921300 New Jersey

Profile Details

NPI number 1952466518
LBN Legal business name Datiashvili, Ramazi Otarovich
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 26th, 2006
Last updated Aug 21st, 2009 - about 17 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1952466518 NPPES
New Jersey MEDICAID 8516006

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