Healthcare Provider Details

I. General information

NPI: 1578491940
Provider Name (Legal Business Name): NIKOLA NIKOLAJEVIC M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PARKWAY SOUTH JACOBI MEDICAL CENTER BUILDING 4, ROOM NUMBER 6511
BRONX NY
10461
US

IV. Provider business mailing address

1400 PELHAM PARKWAY SOUTH JACOBI MEDICAL CENTER BUILDING 4, ROOM NUMBER 6511
BRONX NY
10461
US

V. Phone/Fax

Practice location:
  • Phone: 718-918-5000
  • Fax:
Mailing address:
  • Phone: 718-918-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: