1760640502 NPI number — DR. NIKOLAI YORDANOV MARKOV DO

Table of content: SARAH ALLRED ACMHC (NPI 1730874033)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760640502 NPI number — DR. NIKOLAI YORDANOV MARKOV DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARKOV
Provider First Name:
NIKOLAI
Provider Middle Name:
YORDANOV
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VOROBIEFF
Provider Other First Name:
NICOLAS
Provider Other Middle Name:
CHRISTIAN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760640502
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
424 LAWTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLIFFSIDE PK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07010-1911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-498-2588
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 HOSPITAL PLZ
Provider Second Line Business Practice Location Address:
MEDICAL ARTS BLDG, ST 206
Provider Business Practice Location Address City Name:
OLD BRIDGE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08857-3093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-687-7077
Provider Business Practice Location Address Fax Number:
201-945-5333
Provider Enumeration Date:
05/29/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  25MB08517000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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