Provider Demographics
NPI:1508930678
Name:EVDOKIMOW, DAVID Z (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:Z
Last Name:EVDOKIMOW
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 1:96 S FINLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-1422
Mailing Address - Country:US
Mailing Address - Phone:908-221-1136
Mailing Address - Fax:908-221-0482
Practice Address - Street 1:96 S FINLEY AVE
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-1422
Practice Address - Country:US
Practice Address - Phone:908-221-1136
Practice Address - Fax:908-221-0482
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07315300204E00000X, 208200000X, 2082S0105X, 2086S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH49275Medicare UPIN
NJ051424TRSMedicare ID - Type Unspecified