Individual
DR. MIODRAG RISTICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
201 E 79TH ST, SUITE 7J, NEW YORK, NY 10021-0830
(212) 737-6990
(212) 988-3103
Mailing address
37 SUNRISE LN, UPPER SADDLE RIVER, NJ 07458-1631
(201) 934-5513
(253) 369-8654
Taxonomy
Speciality
Code
Description
License number
State
2084P0805X
Geriatric Psychiatry Physician
Primary
111075
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00198843
—
NY
01
—
111075
HIP
NY
01
—
31O281
EMPIRE BLUE CROSS BLUE SH
NY
01
—
P518630
OXFORD
NY
Enumeration date
01/24/2007
Last updated
07/08/2007
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