Provider Demographics
NPI:1952315384
Name:BOZIC, STANIMIR (MD)
Entity Type:Individual
Prefix:
First Name:STANIMIR
Middle Name:
Last Name:BOZIC
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:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-0270
Mailing Address - Country:US
Mailing Address - Phone:631-264-2035
Mailing Address - Fax:631-264-1418
Practice Address - Street 1:16 GUION PL
Practice Address - Street 2:MONTEFIORE NEW ROCHELLE HOSPITAL
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5502
Practice Address - Country:US
Practice Address - Phone:914-637-1197
Practice Address - Fax:914-637-1627
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138853207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00427541Medicaid
050048932Medicare PIN
B07753Medicare UPIN
NY16A091Medicare PIN