Provider Demographics
NPI:1902635915
Name:KOVACEVIC, BLONDINA (NP)
Entity type:Individual
Prefix:
First Name:BLONDINA
Middle Name:
Last Name:KOVACEVIC
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 136
Mailing Address - Street 2:
Mailing Address - City:HELMETTA
Mailing Address - State:NJ
Mailing Address - Zip Code:08828-0136
Mailing Address - Country:US
Mailing Address - Phone:917-436-9551
Mailing Address - Fax:
Practice Address - Street 1:30 KNIGHTSBRIDGE RD STE 525
Practice Address - Street 2:
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-3963
Practice Address - Country:US
Practice Address - Phone:609-630-0493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY406210363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health