Healthcare Provider Details

I. General information

NPI: 1174449151
Provider Name (Legal Business Name): ASIMA KAJTAZOVIC FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 MAIN ST
WHITESBORO NY
13492-1034
US

IV. Provider business mailing address

111 HOSPITAL DR
UTICA NY
13502-2517
US

V. Phone/Fax

Practice location:
  • Phone: 315-624-8800
  • Fax:
Mailing address:
  • Phone: 315-917-9966
  • Fax: 315-234-3998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF360041-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: