Provider Demographics
NPI:1619157237
Name:OVSJANIKOVSKA, NATALIJA (MD)
Entity Type:Individual
Prefix:MRS
First Name:NATALIJA
Middle Name:
Last Name:OVSJANIKOVSKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319-321 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07505-1805
Mailing Address - Country:US
Mailing Address - Phone:973-523-8316
Mailing Address - Fax:973-523-2248
Practice Address - Street 1:319-321 MAIN ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-1805
Practice Address - Country:US
Practice Address - Phone:973-523-8316
Practice Address - Fax:973-523-2248
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-12
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25 MA08972800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
113465690OtherEMPLOYER TIN
113465690OtherEMPLOYER TIN