MEDICARE: CONSTANTINE KASHNIKOW M.D.

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	207RC0000X	Cardiovascular Disease Physician	MA41487	NJ

Other Identifiers

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

General Provider Information

NPI Number	:	1811956881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONSTANTINE KASHNIKOW M.D.

Provider Business Mailing Address
First Line	:	340 E NORTHFIELD RD
Second Line	:	SUITE 2C
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-4892
Country	:	US
Telephone Number	:	973-994-0069
Fax Number	:	973-994-0567

Provider Business Practice Location Address
First Line	:	340 E NORTHFIELD RD
Second Line	:	SUITE 2C
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-4892
Country	:	US
Telephone Number	:	973-994-0069
Fax Number	:	973-994-0567

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

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	04/29/2010

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