Active NPI
Idelma Kulischenko, MD
- Internal Medicine Physician
- East Brunswick, NJ
National Provider Identifier
1679527790
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MA051157
- Practice address
- 495 Ryders LN
East Brunswick, NJ 08816-2769 - Phone
- (732) 613-9155
- Fax
- (732) 651-0804
- NPI assigned
- May 22, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MA051157 | NJ | Primary |
Addresses
Primary practice location
495 Ryders LN
East Brunswick, NJ 08816-2769
Mailing address
495 Ryders LN
East Brunswick, NJ 08816-2769
Phone (732) 613-9155
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 527195 | Other | NJ | MEDICARE PROVIDER ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA051157 | NJ | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148256000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344988800000",
"number": "1679527790",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "495 RYDERS LN",
"city": "EAST BRUNSWICK",
"state": "NJ",
"postal_code": "088162769",
"telephone_number": "732-613-9155",
"fax_number": "732-651-0804"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "495 RYDERS LN",
"city": "EAST BRUNSWICK",
"state": "NJ",
"postal_code": "088162769",
"telephone_number": "732-613-9155",
"fax_number": "732-651-0804"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KULISCHENKO",
"first_name": "IDELMA",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-22",
"last_updated": "2012-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NJ",
"license": "MA051157",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PROVIDER ID",
"identifier": "527195",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in East Brunswick, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.