Provider Demographics
NPI:1154565927
Name:DIMITRIJEVIC, LJILJANA
Entity type:Individual
Prefix:MS
First Name:LJILJANA
Middle Name:
Last Name:DIMITRIJEVIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 LINWOOD AVE
Mailing Address - Street 2:5A
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-3863
Mailing Address - Country:US
Mailing Address - Phone:201-944-1562
Mailing Address - Fax:
Practice Address - Street 1:2340 LINWOOD AVE
Practice Address - Street 2:5A
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-3863
Practice Address - Country:US
Practice Address - Phone:201-944-1562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007874-1225X00000X
NJ46TR00148800225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics