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: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E 38TH ST
NEW YORK NY
10016-2651
US

IV. Provider business mailing address

160 E 38TH ST
NEW YORK NY
10016-2651
US

V. Phone/Fax

Practice location:
  • Phone: 646-300-4265
  • Fax:
Mailing address:
  • Phone:
  • 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 State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number312085
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: