MEDICARE: KORNELIJA VALIUSKYTE CNIM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0600X	Clinical Neurophysiology Physician	3744	NJ

General Provider Information

NPI Number	:	1386486728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KORNELIJA VALIUSKYTE CNIM

Provider Business Mailing Address
First Line	:	PO BOX 889
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80151-0889
Country	:	US
Telephone Number	:	720-841-6221
Fax Number	:	720-554-7941

Provider Business Practice Location Address
First Line	:	PO BOX 889
Second Line	:
City	:	ENGLEWOOD
State	:	CO
Zip	:	80151-0889
Country	:	US
Telephone Number	:	720-841-6221
Fax Number	:	720-554-7941

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2024
Last Update Date	:	06/07/2024

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