Healthcare Provider Details

I. General information

NPI: 1407358526
Provider Name (Legal Business Name): NIKOLA DJURDJEVIC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 MAIN ST
PATERSON NJ
07503-2621
US

IV. Provider business mailing address

703 MAIN ST
PATERSON NJ
07503-2621
US

V. Phone/Fax

Practice location:
  • Phone: 973-754-2000
  • Fax:
Mailing address:
  • Phone: 973-754-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number312085
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number25MA11730900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: