Provider Demographics
NPI:1780873281
Name:STOJKOVIC JOHNSON, MILI (PT)
Entity type:Individual
Prefix:
First Name:MILI
Middle Name:
Last Name:STOJKOVIC JOHNSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 W 94TH ST
Mailing Address - Street 2:APT. 20K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6999
Mailing Address - Country:US
Mailing Address - Phone:212-531-1623
Mailing Address - Fax:
Practice Address - Street 1:2109 BROADWAY
Practice Address - Street 2:SUITE 204
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2106
Practice Address - Country:US
Practice Address - Phone:212-799-0160
Practice Address - Fax:212-799-0209
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011590225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist