Provider Demographics
NPI:1295209476
Name:DUKANOVIC, ENISA
Entity Type:Individual
Prefix:
First Name:ENISA
Middle Name:
Last Name:DUKANOVIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ENISA
Other - Middle Name:
Other - Last Name:DUKANOVIC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3407 31ST AVE APT 1C
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-1441
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3407 31ST AVE APT 1C
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-1441
Practice Address - Country:US
Practice Address - Phone:347-924-2471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-21
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00532400363A00000X
NY023084363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant