Provider Demographics
NPI:1104034040
Name:RADOSLAV JOVANOVIC, MD LLC
Entity Type:Organization
Organization Name:RADOSLAV JOVANOVIC, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RADOSLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:JOVANOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-249-6709
Mailing Address - Street 1:930 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-2651
Mailing Address - Country:US
Mailing Address - Phone:212-249-6709
Mailing Address - Fax:212-472-7214
Practice Address - Street 1:930 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2651
Practice Address - Country:US
Practice Address - Phone:212-249-6709
Practice Address - Fax:212-472-7214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098582174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB15858Medicare UPIN