Provider Demographics
NPI:1912682279
Name:NJITOR, LIONEL
Entity Type:Individual
Prefix:
First Name:LIONEL
Middle Name:
Last Name:NJITOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6086 SUMMIT CURV S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-4492
Mailing Address - Country:US
Mailing Address - Phone:651-219-4362
Mailing Address - Fax:
Practice Address - Street 1:6086 SUMMIT CURV S
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-4492
Practice Address - Country:US
Practice Address - Phone:651-219-4362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN44033251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health