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Organization
DE OMILIA PLASTIC SURGERY PC
Active
Organization
DE OMILIA PLASTIC SURGERY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID Z EVDOKIMOW MD (OWNER)
(908) 221-1136
Entity
Organization
Contact information
Practice address
96 SOUTH FINLEY AVE, BASKING RIDGE, NJ 07920
(908) 221-1136
(908) 221-0482
Mailing address
96 SOUTH FINLEY AVE, BASKING RIDGE, NJ 07920
(908) 221-1136
(908) 221-0482
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
25MA07315300
NJ
208200000X
Plastic Surgery Physician
25MA07315300
NJ
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
25MA07315300
NJ
Other
Enumeration date
09/20/2007
Last updated
04/03/2008
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