Provider Demographics
NPI:1639580509
Name:KISELOVA, KATERYNA (DO)
Entity Type:Individual
Prefix:DR
First Name:KATERYNA
Middle Name:
Last Name:KISELOVA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 WHITEHORSE MERCERVILLE ROAD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-3834
Mailing Address - Country:US
Mailing Address - Phone:609-587-6661
Mailing Address - Fax:
Practice Address - Street 1:1690 BIG OAK RD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-6421
Practice Address - Country:US
Practice Address - Phone:215-736-9362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB10696300207Q00000X
PAOS018475207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine