Provider Demographics
NPI:1801118252
Name:KRSTIC, JASMINA (MD)
Entity type:Individual
Prefix:
First Name:JASMINA
Middle Name:
Last Name:KRSTIC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JASMINA
Other - Middle Name:
Other - Last Name:FILIPOVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:81 MAPLE AVE S
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-6339
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL PLZ
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3602
Practice Address - Country:US
Practice Address - Phone:203-276-7298
Practice Address - Fax:203-276-4842
Is Sole Proprietor?:No
Enumeration Date:2010-02-25
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT61123207R00000X, 207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03658844Medicaid
NY03658844Medicaid