Provider Demographics
NPI:1861806705
Name:MARKOV, EMILIJA
Entity type:Individual
Prefix:MS
First Name:EMILIJA
Middle Name:
Last Name:MARKOV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1939 GATES AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-2434
Mailing Address - Country:US
Mailing Address - Phone:917-583-0244
Mailing Address - Fax:
Practice Address - Street 1:1939 GATES AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-2434
Practice Address - Country:US
Practice Address - Phone:917-583-0244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY656077121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist