Healthcare Provider Details

I. General information

NPI: 1417944398
Provider Name (Legal Business Name): STANISLAV DAVID JIVOTOVSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NORTHERN WESTCHESTER HOSPITAL 400 EAST MAIN STREET
MOUNT KISCO NY
10549
US

IV. Provider business mailing address

118 N BEDFORD RD STE 200
MOUNT KISCO NY
10549-2555
US

V. Phone/Fax

Practice location:
  • Phone: 914-666-1691
  • Fax:
Mailing address:
  • Phone: 914-666-8866
  • Fax: 914-666-6777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number62373
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number232406
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: