Individual
DR. LUDMILA IVCHENKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
ONE HOSPITAL PLAZA, OLD BRIDGE, NJ 08857-3087
(732) 360-4019
Mailing address
66 WEST GILBERT STREET, SUITE 100, RED BANK, NJ 07701-4918
(732) 212-0060
(732) 212-0061
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MA07409900
NJ
208D00000X
General Practice Physician
25MA07409900
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0069736
—
NJ
Enumeration date
08/19/2005
Last updated
02/22/2008
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