MEDICARE: DR. JOHN P CVITKOVIC PA-C, PT, C.PED, CFO

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225000000X	Orthotic Fitter	CFO02565	DE
2	224L00000X	Pedorthist	CPED1198	DE
3	225100000X	Physical Therapist	019369	NY
4	363A00000X	Physician Assistant	008387	NY
5	222Z00000X	Orthotist		NY

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000180974616	OTHER	NY	OPTUM HEALTH PHYSICAL THERAPY-UNITED HEALTHCARE
2	0401995	OTHER	NY	AETNA- LOCAL 1199/ORTHONET
3	272438120	OTHER	NY	POMCO
4	616130500	OTHER	NY	FECA/ OFFICE OF FEDERAL WORKERS COMPENSATION
5	272438120	OTHER	NY	MAGNACARE
6	P4162456	OTHER	NY	OPTUM HEALTH PHYSICAL THERAPY- OXFORD HEALTH PLAN-FREEDOM/LIBERTY
7	Q622E1	OTHER	NY	EMPIRE BLUE CROSS
8	11556837	OTHER		CAQH
9	272438120	OTHER	NY	MULTIPLAN-GEHA
10	272438120	OTHER	NY	AGEWELL HEALTH PLAN
11	3017337	OTHER	NY	MVP
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	272438120	OTHER	NY	AMERIGROUP HEALTH PLAN
14	272438120	OTHER	NY	VNS CHOICE HEALTH PLAN
15	0401995	OTHER	NY	AETNA-ORTHONET
16	272438120	OTHER	NY	HUMANA HEALTH PLAN
17	703204	OTHER	NY	OPTUM HEALTH PHYSICAL THERAPY- EMPIRE STATE AND ORANGE COUNTY
18	0401995	OTHER	NY	CIGNA HEALTHCARE-ORTHONET
19	272438120	OTHER	NY	MULTI-PLAN
20	272438120	OTHER	NY	AFFINITY HEALTH PLAN
21	272438120	OTHER	NY	HUDSON HEALTH PLAN

NPI Number	:	1558349779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN P CVITKOVIC PA-C, PT, C.PED, CFO

Provider Business Mailing Address
First Line	:	115 MAIN ST
Second Line	:	SUITE 202
City	:	TUCKAHOE
State	:	NY
Zip	:	10707-2948
Country	:	US
Telephone Number	:	914-961-1600
Fax Number	:	888-270-4616

Provider Business Practice Location Address
First Line	:	1650 GRAND CONCOURSE
Second Line	:	7TH FLOOR
City	:	BRONX
State	:	NY
Zip	:	10457-7606
Country	:	US
Telephone Number	:	914-961-1600
Fax Number	:	888-270-4616

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2006
Last Update Date	:	03/07/2023

1650 GRAND CONCOURSE , BRONX LEBANON HOSPITAL, 5TH FLOOR OB-GYN
BRONX, NY
10457-7606

Practice Phone: 718-239-8383
Practice Fax: