Provider Demographics
NPI:1619728078
Name:MOMIROVIC, BRANKA (MSED)
Entity Type:Individual
Prefix:
First Name:BRANKA
Middle Name:
Last Name:MOMIROVIC
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5906B 38TH AVE APT B6
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-2558
Mailing Address - Country:US
Mailing Address - Phone:914-282-7183
Mailing Address - Fax:
Practice Address - Street 1:5906B 38TH AVE APT B6
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-2558
Practice Address - Country:US
Practice Address - Phone:914-282-7183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3027029174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist