Individual
DR. TEIMOURAZ VASSILIDZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
225 WILLIAMSON STREET, ELIZABETH, NJ 07202
(908) 994-5204
Mailing address
20 SHERWOOD DR, WATCHUNG, NJ 07069-6136
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
25MA06904200
NJ
207L00000X
Anesthesiology Physician
291354
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7966806
—
NJ
Enumeration date
07/19/2006
Last updated
06/05/2018
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