Provider Demographics
NPI:1417944398
Name:JIVOTOVSKI, STANISLAV DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:STANISLAV
Middle Name:DAVID
Last Name:JIVOTOVSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 N BEDFORD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-2555
Mailing Address - Country:US
Mailing Address - Phone:914-666-8866
Mailing Address - Fax:914-666-6777
Practice Address - Street 1:NORTHERN WESTCHESTER HOSPITAL
Practice Address - Street 2:400 EAST MAIN STREET
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549
Practice Address - Country:US
Practice Address - Phone:914-666-1691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT62373207L00000X
NY232406207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02551866Medicaid
NY02551866Medicaid
NYI04114Medicare UPIN