Provider Demographics
NPI:1437589892
Name:DJUKANOVIC, FAHRUDIN
Entity Type:Individual
Prefix:
First Name:FAHRUDIN
Middle Name:
Last Name:DJUKANOVIC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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:347-924-2474
Mailing Address - Fax:
Practice Address - Street 1:145 E 32ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6055
Practice Address - Country:US
Practice Address - Phone:212-427-3986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-22
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical