MEDICARE: LUTSIYA S PELIMSKAYA MD

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	207R00000X	Internal Medicine Physician	25MA07628200	NJ

General Provider Information

NPI Number	:	1609886902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUTSIYA S PELIMSKAYA MD

Provider Business Mailing Address
First Line	:	8008 ROUTE 130 STE 120
Second Line	:
City	:	DELRAN
State	:	NJ
Zip	:	08075-1869
Country	:	US
Telephone Number	:	856-764-1840
Fax Number	:	856-764-7997

Provider Business Practice Location Address
First Line	:	8008 ROUTE 130 STE 120
Second Line	:
City	:	DELRAN
State	:	NJ
Zip	:	08075-1869
Country	:	US
Telephone Number	:	856-764-1840
Fax Number	:	856-764-7997

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	12/23/2019

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