Provider Demographics
NPI:1225095672
Name:SOLOMONOV, MIKHAIL (MD)
Entity Type:Individual
Prefix:
First Name:MIKHAIL
Middle Name:
Last Name:SOLOMONOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SADDLE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CEDAR KNOLLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07927-1902
Mailing Address - Country:US
Mailing Address - Phone:973-998-7868
Mailing Address - Fax:973-998-7883
Practice Address - Street 1:8 SADDLE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-1902
Practice Address - Country:US
Practice Address - Phone:973-998-7868
Practice Address - Fax:973-998-7883
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07903700207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJI01673Medicare UPIN
NJ100876Medicare PIN