Individual
IDA JIVOTOVSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1200 HIGH RIDGE RD STE 3, STAMFORD, CT 06905-1202
(465) 813-2176
Mailing address
51 DENNIS LN, PLEASANTVILLE, NY 10570-1032
(631) 316-4553
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
9884
CT
Other
Enumeration date
08/21/2021
Last updated
11/22/2024
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