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NPI Code Detail

MEDICARE: MR. EVGENY SHELKOV CNIM

MEDICARE: MR. EVGENY SHELKOV CNIM
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
1156F00000XTechnician/Technologist1759NJ

General Provider Information

NPI Number : 1831052067
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EVGENY SHELKOV CNIM
Provider Business Mailing Address
First Line : 7002 KENNEDY BLVD E APT 21F
Second Line :
City : GUTTENBERG
State : NJ
Zip : 07093-4920
Country : US
Telephone Number : 973-339-7013
Fax Number :
Provider Business Practice Location Address
First Line : 350 BOULEVARD
Second Line :
City : PASSAIC
State : NJ
Zip : 07055-2840
Country : US
Telephone Number : 973-365-4300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2025
Last Update Date : 12/04/2025

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