Healthcare Provider Details

I. General information

NPI: 1366456337
Provider Name (Legal Business Name): SVETLANA BIKVAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 MAIN ST ER DEPT
PATERSON NJ
07503
US

IV. Provider business mailing address

PO BOX 51003
NEWARK NJ
07101
US

V. Phone/Fax

Practice location:
  • Phone: 973-754-2000
  • Fax:
Mailing address:
  • Phone: 866-687-1790
  • Fax: 616-975-9827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number070962
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0090565
Identifier TypeMEDICAID
Identifier StateNJ
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: