Provider Demographics
NPI:1750915062
Name:RADOSLAV JOVANOVIC, MD AND KEVIN JOVANOVIC, MD
Entity type:Organization
Organization Name:RADOSLAV JOVANOVIC, MD AND KEVIN JOVANOVIC, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOVANOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-249-6709
Mailing Address - Street 1:930 FIFTH AVENUE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-249-6709
Mailing Address - Fax:
Practice Address - Street 1:930 FIFTH AVENUE
Practice Address - Street 2:SUITE 3
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-249-6709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RADOSLAV AND KEVIN JOVANOVIC MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02635409Medicaid