Individual
DR. OLEG FOMITCHEV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
350 BOULEVARD, PASSAIC, NJ 07055-2840
(973) 365-4489
Mailing address
350 BOULEVARD, PASSAIC, NJ 07055-2840
(973) 365-4489
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
25MA08109100
NJ
207Q00000X
Family Medicine Physician
26893
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51531294
BLUE CROSS BLUE SHIELD
AL
Enumeration date
03/02/2006
Last updated
04/04/2017
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