Provider Demographics
NPI:1760640502
Name:MARKOV, NIKOLAI YORDANOV (DO)
Entity Type:Individual
Prefix:DR
First Name:NIKOLAI
Middle Name:YORDANOV
Last Name:MARKOV
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:NICOLAS
Other - Middle Name:CHRISTIAN
Other - Last Name:VOROBIEFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:424 LAWTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFFSIDE PK
Mailing Address - State:NJ
Mailing Address - Zip Code:07010-1911
Mailing Address - Country:US
Mailing Address - Phone:615-498-2588
Mailing Address - Fax:
Practice Address - Street 1:3 HOSPITAL PLZ
Practice Address - Street 2:MEDICAL ARTS BLDG, ST 206
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3093
Practice Address - Country:US
Practice Address - Phone:732-687-7077
Practice Address - Fax:201-945-5333
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08517000208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery