Provider Demographics
NPI:1871547950
Name:KATSEVA, ALLA (MD)
Entity type:Individual
Prefix:DR
First Name:ALLA
Middle Name:
Last Name:KATSEVA
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:PO BOX 58
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-0058
Mailing Address - Country:US
Mailing Address - Phone:732-238-8200
Mailing Address - Fax:732-651-6500
Practice Address - Street 1:561 CRANBURY RD
Practice Address - Street 2:SUITE M
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5400
Practice Address - Country:US
Practice Address - Phone:732-238-8200
Practice Address - Fax:732-651-6500
Is Sole Proprietor?:No
Enumeration Date:2006-05-21
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07544800207R00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0038431Medicaid
NJ082969Medicare ID - Type Unspecified
NJ0038431Medicaid