Provider Demographics
NPI:1003017443
Name:BLOKAR, MIRJANA (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRJANA
Middle Name:
Last Name:BLOKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 BLEECKER ST
Mailing Address - Street 2:12TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-2420
Mailing Address - Country:US
Mailing Address - Phone:212-505-2652
Mailing Address - Fax:
Practice Address - Street 1:65 BLEECKER ST
Practice Address - Street 2:12TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2420
Practice Address - Country:US
Practice Address - Phone:212-505-2652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137190102L00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00367946Medicaid
NY22A181Medicare ID - Type Unspecified
NY00367946Medicaid