Provider Demographics
NPI:1396753604
Name:STEFANOVICH, MICHAEL VLADIMIR (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:VLADIMIR
Last Name:STEFANOVICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:214 ENGLE ST STE 20
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2418
Mailing Address - Country:US
Mailing Address - Phone:201-266-5146
Mailing Address - Fax:201-266-5267
Practice Address - Street 1:214 ENGLE ST STE 20
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2418
Practice Address - Country:US
Practice Address - Phone:201-266-5146
Practice Address - Fax:201-266-5267
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2026872084P0800X
NJMA 647602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry