Provider Demographics
NPI:1235429911
Name:ANNA J. LAVOTSHKIN, MD, PC
Entity Type:Organization
Organization Name:ANNA J. LAVOTSHKIN, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALTANOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-833-2288
Mailing Address - Street 1:757 TEANECK RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4241
Mailing Address - Country:US
Mailing Address - Phone:201-833-2288
Mailing Address - Fax:201-833-4441
Practice Address - Street 1:757 TEANECK RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4241
Practice Address - Country:US
Practice Address - Phone:201-833-2288
Practice Address - Fax:201-833-4441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ54741MA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty