Basic Information
| Provider Information | |||||||||
| NPI: | 1487603007 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOSIFOVSKI | ||||||||
| FirstName: | PANDE | ||||||||
| MiddleName: | VASIL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 123 HIGHLAND AVE | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | GLEN RIDGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070281527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737480678 | ||||||||
| FaxNumber: | 9737482808 | ||||||||
| Practice Location | |||||||||
| Address1: | 123 HIGHLAND AVE | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | GLEN RIDGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070281527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737480678 | ||||||||
| FaxNumber: | 9737482808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2006 | ||||||||
| LastUpdateDate: | 06/03/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 25MA02629900 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1696904 | 05 | NJ | MEDICAID |