Provider Demographics
NPI:1972125839
Name:IVANOVSKI, VLADIMIR
Entity Type:Individual
Prefix:MR
First Name:VLADIMIR
Middle Name:
Last Name:IVANOVSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:VLADIMIR
Other - Middle Name:
Other - Last Name:IVANOVSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:306 DANBURY LN
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-7519
Mailing Address - Country:US
Mailing Address - Phone:914-826-6922
Mailing Address - Fax:
Practice Address - Street 1:306 DANBURY LN
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-7519
Practice Address - Country:US
Practice Address - Phone:914-826-6922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-14
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY762366163W00000X
NJ26NR22190600163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse