Provider Demographics
NPI:1801942313
Name:MARINKOVIC, PETER M
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:M
Last Name:MARINKOVIC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 S FARVIEW AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-2501
Mailing Address - Country:US
Mailing Address - Phone:201-909-0502
Mailing Address - Fax:201-909-0377
Practice Address - Street 1:107 S FARVIEW AVE
Practice Address - Street 2:SUITE C
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2501
Practice Address - Country:US
Practice Address - Phone:201-909-0502
Practice Address - Fax:201-909-0377
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC00628900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor