Provider Demographics
NPI:1265788053
Name:WINTER, IVAN DAVID (MD)
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:DAVID
Last Name:WINTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9226 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-5312
Mailing Address - Country:US
Mailing Address - Phone:973-723-4476
Mailing Address - Fax:
Practice Address - Street 1:9226 KENNEDY BLVD FL 2
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-5312
Practice Address - Country:US
Practice Address - Phone:201-863-3055
Practice Address - Fax:201-863-5744
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA05367900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine