Provider Demographics
NPI:1144248311
Name:KISHKAREVA, NATALYA (MD)
Entity type:Individual
Prefix:DR
First Name:NATALYA
Middle Name:
Last Name:KISHKAREVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SOMERSET RD
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07648-1912
Mailing Address - Country:US
Mailing Address - Phone:732-996-5438
Mailing Address - Fax:201-750-0957
Practice Address - Street 1:18 SOMERSET RD
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07648-1912
Practice Address - Country:US
Practice Address - Phone:732-996-5438
Practice Address - Fax:201-750-0957
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2180702084P0800X
NJ25MA083208002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH44636Medicare UPIN
NY007BC1Medicare ID - Type Unspecified