Provider Demographics
NPI:1972053775
Name:JOKSIMOVIC, MARIJA (MS LAC)
Entity Type:Individual
Prefix:
First Name:MARIJA
Middle Name:
Last Name:JOKSIMOVIC
Suffix:
Gender:F
Credentials:MS LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 DIVISION AVE
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-4406
Mailing Address - Country:US
Mailing Address - Phone:845-642-4349
Mailing Address - Fax:
Practice Address - Street 1:78 S MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2961
Practice Address - Country:US
Practice Address - Phone:845-642-4349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005775171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist