Individual
OLEG GUSAKOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 ROBERT WOOD JOHNSON PL, NEW BRUNSWICK, NJ 08901-1928
(732) 828-3000
Mailing address
PO BOX 829642, PHILADELPHIA, PA 19182-9642
(866) 470-6626
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
229754
MA
207L00000X
Anesthesiology Physician
239565
MA
207L00000X
Anesthesiology Physician
Primary
25MA10467000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110082461A
—
MA
Enumeration date
04/28/2008
Last updated
07/23/2021
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