Provider Demographics
NPI:1396176970
Name:KOLESNIKOVICH, RUVIM
Entity type:Individual
Prefix:
First Name:RUVIM
Middle Name:
Last Name:KOLESNIKOVICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 TOMLINSON RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-4218
Mailing Address - Country:US
Mailing Address - Phone:215-789-8651
Mailing Address - Fax:215-689-4232
Practice Address - Street 1:27 TOMLINSON RD
Practice Address - Street 2:SUITE 103
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-4218
Practice Address - Country:US
Practice Address - Phone:215-789-8651
Practice Address - Fax:215-689-4232
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA129209146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic