Provider Demographics
NPI:1588871966
Name:OLEG KAIM, M.D., P.C.
Entity type:Organization
Organization Name:OLEG KAIM, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLEG
Authorized Official - Middle Name:
Authorized Official - Last Name:KAIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-567-4488
Mailing Address - Street 1:214 ENGLE ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2418
Mailing Address - Country:US
Mailing Address - Phone:201-567-4488
Mailing Address - Fax:201-567-4771
Practice Address - Street 1:214 ENGLE ST
Practice Address - Street 2:SUITE 11
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2418
Practice Address - Country:US
Practice Address - Phone:201-567-4488
Practice Address - Fax:201-567-4771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06193500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6651208Medicaid
NJ6651208Medicaid
NJ117720Medicare PIN