Provider Demographics
NPI:1366423295
Name:MILOS, JOVAN (MD)
Entity type:Individual
Prefix:DR
First Name:JOVAN
Middle Name:
Last Name:MILOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7128 COOPER AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7259
Mailing Address - Country:US
Mailing Address - Phone:718-418-7681
Mailing Address - Fax:718-417-3570
Practice Address - Street 1:7128 COOPER AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7259
Practice Address - Country:US
Practice Address - Phone:718-418-7681
Practice Address - Fax:718-417-3570
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218660207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02134412Medicaid
H30957Medicare UPIN
NY232L51Medicare ID - Type Unspecified
NY02134412Medicaid