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General NPI Number Information
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NPI Number | 1174853378
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Entity Type | Organization
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Legal Business Name | VELJKO KRSTULOVIC
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Dates
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Enumeration Date | 01/11/2010
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Last Update Date | 01/11/2010
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Provider Practice Location Address
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Address Line | 1090 AMSTERDAM AVE
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City | NEW YORK
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State | NY
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Zip | 10025-1737
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Country | US
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Telephone | 212-665-3326
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Fax |
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Provider Business Mailing Address
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Address Line | 1090 AMSTERDAM AVE
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City | NEW YORK
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State | NY
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Zip | 10025-1737
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Country | US
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Telephone | 212-665-3326
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Fax |
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Authorized Official
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Title or Position | ACCOUNT MANAGER
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Name | ELLEN RIFKEN
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Credential |
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Telephone | 845-426-6864
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 123456
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License Number State | NY
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