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NPI Code Detail

MEDICARE: LENA KHAYLOMSKY DMD

MEDICARE: LENA KHAYLOMSKY DMD
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
11223G0001XGeneral Practice Dentistry22424NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417107178
Entity Type Code : Individual
Provider Name (Legal Business Name) : LENA KHAYLOMSKY DMD
Provider Business Mailing Address
First Line : 4100 PARK AVE
Second Line :
City : WEEHAWKEN
State : NJ
Zip : 07086-6196
Country : US
Telephone Number : 201-348-1616
Fax Number : 201-348-4877
Provider Business Practice Location Address
First Line : 4100 PARK AVE
Second Line :
City : WEEHAWKEN
State : NJ
Zip : 07086-6196
Country : US
Telephone Number : 201-348-1616
Fax Number : 201-348-4877
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2008
Last Update Date : 02/02/2015

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Directions to “ LENA KHAYLOMSKY DMD” Practice Location

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