Healthcare Provider Details

I. General information

NPI: 1912296674
Provider Name (Legal Business Name): KSENIYA KOBETS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE STE 702
HACKENSACK NJ
07601-1974
US

IV. Provider business mailing address

121 S HIGHLAND AVE APT 604
PITTSBURGH PA
15206-3910
US

V. Phone/Fax

Practice location:
  • Phone: 908-359-8980
  • Fax:
Mailing address:
  • Phone: 845-505-4277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMT202286
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number25MA10109700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: