MEDICARE: MILI STOJKOVIC JOHNSON PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	011590	NY

General Provider Information

NPI Number	:	1780873281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILI STOJKOVIC JOHNSON PT

Provider Business Mailing Address
First Line	:	255 W 94TH ST
Second Line	:	APT. 20K
City	:	NEW YORK
State	:	NY
Zip	:	10025-6999
Country	:	US
Telephone Number	:	212-531-1623
Fax Number	:

Provider Business Practice Location Address
First Line	:	2109 BROADWAY
Second Line	:	SUITE 204
City	:	NEW YORK
State	:	NY
Zip	:	10023-2106
Country	:	US
Telephone Number	:	212-799-0160
Fax Number	:	212-799-0209

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2007
Last Update Date	:	10/19/2007

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