Healthcare Provider Details

I. General information

NPI: 1780873281
Provider Name (Legal Business Name): MILI STOJKOVIC JOHNSON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 BROADWAY SUITE 204
NEW YORK NY
10023-2106
US

IV. Provider business mailing address

255 W 94TH ST APT. 20K
NEW YORK NY
10025-6999
US

V. Phone/Fax

Practice location:
  • Phone: 212-799-0160
  • Fax: 212-799-0209
Mailing address:
  • Phone: 212-531-1623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number011590
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: