Provider Demographics
NPI:1902114705
Name:PETAR JOVANOVIC MD PC
Entity Type:Organization
Organization Name:PETAR JOVANOVIC MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETAR
Authorized Official - Middle Name:
Authorized Official - Last Name:JOVANOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-861-4480
Mailing Address - Street 1:208 E 75 STR
Mailing Address - Street 2:
Mailing Address - City:N.Y.C.
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-861-4480
Mailing Address - Fax:
Practice Address - Street 1:208 E 75 STR
Practice Address - Street 2:
Practice Address - City:N.Y.C.
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-861-4480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB78443Medicare UPIN
NY631911Medicare PIN