Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 242475 | NY |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 4301064159 | MI |
NPI | 1073550562 |
---|---|
Provider Name | Predrag Popovic |
First Address | New York, NY 10032-3725 |
Second Address | New York, NY 10034-1159 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 16/06/2017 |