Individual
DR. IDELMA KULISCHENKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
495 RYDERS LN, EAST BRUNSWICK, NJ 08816-2769
(732) 613-9155
(732) 651-0804
Mailing address
495 RYDERS LN, EAST BRUNSWICK, NJ 08816-2769
(732) 613-9155
(732) 651-0804
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MA051157
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
527195
MEDICARE PROVIDER ID
NJ
Enumeration date
05/22/2006
Last updated
08/15/2012
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