Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | A87463 | CA |
NPI | 1023048865 |
---|---|
Provider Name | Dr. Miroslav Djokic |
First Address | Amityville, NY 11701-2780 |
Second Address | Amityville, NY 11701-2780 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 01/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A874630 | (05) | CA |
I10150 | (02) | CA |