Provider Demographics
NPI:1164628392
Name:MEDLENOV, SERGEY (DO)
Entity Type:Individual
Prefix:DR
First Name:SERGEY
Middle Name:
Last Name:MEDLENOV
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 LAUREL ROAD
Mailing Address - Street 2:
Mailing Address - City:STRATFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08084-1801
Mailing Address - Country:US
Mailing Address - Phone:856-346-7985
Mailing Address - Fax:
Practice Address - Street 1:18 LAUREL ROAD
Practice Address - Street 2:
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1801
Practice Address - Country:US
Practice Address - Phone:856-346-7985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2017-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08330100207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine