Provider Demographics
NPI:1558349779
Name:CVITKOVIC, JOHN P (PA-C, PT, CPED, CFO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:CVITKOVIC
Suffix:
Gender:M
Credentials:PA-C, PT, CPED, CFO
Other - Prefix:
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Mailing Address - Street 1:115 MAIN ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-2948
Mailing Address - Country:US
Mailing Address - Phone:914-961-1600
Mailing Address - Fax:888-270-4616
Practice Address - Street 1:1650 GRAND CONCOURSE
Practice Address - Street 2:7TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7606
Practice Address - Country:US
Practice Address - Phone:914-961-1600
Practice Address - Fax:888-270-4616
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DECFO02565225000000X
DECPED1198224L00000X
NY019369225100000X
NY008387363A00000X
NY222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0000180974616OtherOPTUM HEALTH PHYSICAL THERAPY-UNITED HEALTHCARE
NY0401995OtherAETNA- LOCAL 1199/ORTHONET
NY272438120OtherPOMCO
NY616130500OtherFECA/ OFFICE OF FEDERAL WORKERS COMPENSATION
NY272438120OtherMAGNACARE
NYP4162456OtherOPTUM HEALTH PHYSICAL THERAPY- OXFORD HEALTH PLAN-FREEDOM/LIBERTY
NYQ622E1OtherEMPIRE BLUE CROSS
11556837OtherCAQH
NY272438120OtherMULTIPLAN-GEHA
NY272438120OtherAGEWELL HEALTH PLAN
NY3017337OtherMVP
NY03021730Medicaid
NY272438120OtherAMERIGROUP HEALTH PLAN
NY272438120OtherVNS CHOICE HEALTH PLAN
NY0401995OtherAETNA-ORTHONET
NY272438120OtherHUMANA HEALTH PLAN
NY703204OtherOPTUM HEALTH PHYSICAL THERAPY- EMPIRE STATE AND ORANGE COUNTY
NY0401995OtherCIGNA HEALTHCARE-ORTHONET
NY272438120OtherMULTI-PLAN
NY272438120OtherAFFINITY HEALTH PLAN
NY272438120OtherHUDSON HEALTH PLAN
NY272438120OtherHUDSON HEALTH PLAN
NY272438120OtherPOMCO