Provider Demographics
NPI:1245281484
Name:ALTSHULER & KONNICK LLC
Entity type:Organization
Organization Name:ALTSHULER & KONNICK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCCELLATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-683-7959
Mailing Address - Street 1:256 BUNN DR
Mailing Address - Street 2:SUITE 3 A
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-2859
Mailing Address - Country:US
Mailing Address - Phone:609-683-7773
Mailing Address - Fax:609-683-7958
Practice Address - Street 1:256 BUNN DR
Practice Address - Street 2:SUITE 3 A
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-2859
Practice Address - Country:US
Practice Address - Phone:609-683-7773
Practice Address - Fax:609-683-7958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05452200174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ=========OtherTAX ID