Provider Demographics
NPI:1568532687
Name:PEKOVIC, DUSAN I (MD)
Entity Type:Individual
Prefix:
First Name:DUSAN
Middle Name:I
Last Name:PEKOVIC
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 1:333 E 46 STREET
Mailing Address - Street 2:APT 1G
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10017
Mailing Address - Country:US
Mailing Address - Phone:212-661-9449
Mailing Address - Fax:212-661-1882
Practice Address - Street 1:333 E 46 STREET
Practice Address - Street 2:APT 1G
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10017
Practice Address - Country:US
Practice Address - Phone:216-661-9449
Practice Address - Fax:212-661-1882
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1978412084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02145848Medicaid