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General NPI Number Information
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NPI Number | 1285501460
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Entity Type | Individual
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Provider Name | PETAR R BANOVIC
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Gender | Male
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Dates
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Enumeration Date | 10/21/2025
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 2141 PALMER AVE
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City | LARCHMONT
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State | NY
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Zip | 10538-2406
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Country | US
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Telephone | 914-341-1900
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Fax |
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Provider Business Mailing Address
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Address Line | 1447 159TH ST
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City | WHITESTONE
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State | NY
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Zip | 11357-2720
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Country | US
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Telephone | 914-708-9618
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 073087
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License Number State | NY
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