MEDICARE: DR. VESNA NIKODIJEVIC M.D.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	25MA07685300	NJ

General Provider Information

NPI Number	:	1952497224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VESNA NIKODIJEVIC M.D.

Provider Business Mailing Address
First Line	:	40 MORRISTOWN RD STE 2D
Second Line	:
City	:	BERNARDSVILLE
State	:	NJ
Zip	:	07924-2310
Country	:	US
Telephone Number	:	908-766-5960
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 MORRISTOWN RD
Second Line	:	SUITE 2D
City	:	BERNARDSVILLE
State	:	NJ
Zip	:	07924-2310
Country	:	US
Telephone Number	:	908-766-5960
Fax Number	:	866-768-8391

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	10/12/2012

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