Healthcare Provider Details

I. General information

NPI: 1417955980
Provider Name (Legal Business Name): KEVIN JOVANOVIC M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 5TH AVE
NEW YORK NY
10021-2651
US

IV. Provider business mailing address

930 5TH AVE
NEW YORK NY
10021-2651
US

V. Phone/Fax

Practice location:
  • Phone: 212-249-6709
  • Fax: 212-472-7214
Mailing address:
  • Phone: 212-249-6709
  • Fax: 212-472-7214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number233663
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: