Provider Demographics
NPI:1679594923
Name:DEMIDOWICH, GEORGE (MD, FACC)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:DEMIDOWICH
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:340 E NORTHFIELD RD
Practice Address - Street 2:SUITE 1-B
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4892
Practice Address - Country:US
Practice Address - Phone:973-994-0880
Practice Address - Fax:973-994-9408
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03396800207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3014801Medicaid
NJC52913Medicare UPIN
NJ604756Medicare ID - Type Unspecified