Provider Demographics
NPI:1093800377
Name:PEKOVIC, OLIVERA D (MD)
Entity Type:Individual
Prefix:DR
First Name:OLIVERA
Middle Name:D
Last Name:PEKOVIC
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 1:600 E 233RD STREET
Mailing Address - Street 2:DEPT. OF PHYSICAL & REHABILITATION MEDICINE
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 E 233RD STREET
Practice Address - Street 2:DEPT. OF PHYSICAL & REHABILITATION MEDICINE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466
Practice Address - Country:US
Practice Address - Phone:718-920-9171
Practice Address - Fax:718-920-9212
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205143208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG63738Medicare UPIN
NY59593Medicare ID - Type Unspecified