1760640502 NPI number — DR. NIKOLAI YORDANOV MARKOV DO

Table of content: DR. NIKOLAI YORDANOV MARKOV DO (NPI 1760640502)

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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