Healthcare Provider Details

I. General information

NPI: 1942578968
Provider Name (Legal Business Name): CHRISTOPHER LJUCOVIC FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2011
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 47TH AVE STE 635
LONG ISLAND CITY NY
11101-3492
US

IV. Provider business mailing address

3030 47TH AVE STE 635
LONG ISLAND CITY NY
11101-3492
US

V. Phone/Fax

Practice location:
  • Phone: 718-472-1999
  • Fax: 718-472-5222
Mailing address:
  • Phone: 718-472-1999
  • Fax: 718-472-5222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number346167
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: