Healthcare Provider Details

I. General information

NPI: 1871023903
Provider Name (Legal Business Name): KATERYNA HUELSKAMP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATERYNA YEVDOKIMOVA MD

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653 WILLOW GROVE ST STE 2000
HACKETTSTOWN NJ
07840-1789
US

IV. Provider business mailing address

PO BOX 416457
BOSTON MA
02241-6457
US

V. Phone/Fax

Practice location:
  • Phone: 908-522-5120
  • Fax: 908-813-8326
Mailing address:
  • Phone: 844-362-1735
  • Fax: 973-290-7495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number25MA11943100
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number25MA11943100
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD481627
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: