Provider Demographics
NPI:1700924669
Name:POVZHITKOV, IGOR M (MD)
Entity Type:Individual
Prefix:DR
First Name:IGOR
Middle Name:M
Last Name:POVZHITKOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:343 ELLEN PL
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-5506
Mailing Address - Country:US
Mailing Address - Phone:201-218-6439
Mailing Address - Fax:201-632-6403
Practice Address - Street 1:520 SYLVAN AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:ENGLEWOOD CLIFFS
Practice Address - State:NJ
Practice Address - Zip Code:07632-3022
Practice Address - Country:US
Practice Address - Phone:201-816-1991
Practice Address - Fax:201-632-6403
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07341800207L00000X, 207LP2900X
NY216770-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH17220Medicare UPIN