Provider Demographics
NPI:1023048865
Name:DJOKIC, MIROSLAV (MD)
Entity type:Individual
Prefix:DR
First Name:MIROSLAV
Middle Name:
Last Name:DJOKIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 BROADWAY
Mailing Address - Street 2:SUITE 204
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2780
Mailing Address - Country:US
Mailing Address - Phone:631-598-5864
Mailing Address - Fax:631-598-5866
Practice Address - Street 1:221 BROADWAY
Practice Address - Street 2:SUITE 204
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2780
Practice Address - Country:US
Practice Address - Phone:631-598-5864
Practice Address - Fax:631-598-5866
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87463207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A874630Medicaid
CA00A874630Medicaid
CA00A874630Medicare ID - Type Unspecified