Healthcare Provider Details

I. General information

NPI: 1871547950
Provider Name (Legal Business Name): ALLA KATSEVA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2006
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 CRANBURY RD SUITE M
EAST BRUNSWICK NJ
08816-5400
US

IV. Provider business mailing address

PO BOX 58
EAST BRUNSWICK NJ
08816-0058
US

V. Phone/Fax

Practice location:
  • Phone: 732-238-8200
  • Fax: 732-651-6500
Mailing address:
  • Phone: 732-238-8200
  • Fax: 732-651-6500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA07544800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA07544800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: