MR. PETKO PETKOV MITEV (NPI# 1881981348) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881981348 |
| Entity Type | Individual |
| Full Name | MR. PETKO PETKOV MITEV |
| Credential | PA-C |
| Practice Address |
695 Us Highway 46 Suite 400a Fairfield NJ 07004-1592 |
| Mailing Address |
Po Box 4059 Wayne NJ 07474-4059 |
| Practice Telephone | 9738941263 |
| Practice Fax Number | 8889723703 |
| Mailing Telephone | 9738941263 |
| Mailing Fax Number | 8889723703 |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2017-01-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
25MP00262400 | NJ | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
695 US HIGHWAY 46 SUITE 400A |
| City | FAIRFIELD |
| State | NJ |
| Zip Code | 07004-1592 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063406874 | Mary F Welsh | Surgery | 695 Us Highway 46, Suite 400a, Fairfield, NJ 07004-1592 | 2005-09-07 |
| 1336648708 | Nancyann Cole | Physician Assistant | 695 Us Highway 46, Fairfield, NJ 07004-1592 | 2018-02-12 |
| 1932445285 | Barry A Cohen LLC | Surgery | 695 Us Highway 46, Suite 400a, Fairfield, NJ 07004-1592 | 2012-12-13 |
| 1306122874 | Lynn Malanka | Nurse Practitioner | 695 Us Highway 46, Ste 400a, Fairfield, NJ 07004-1568 | 2011-10-28 |
| 1962787986 | Sweta G Dalsania | Physician Assistant | 695 Us Highway 46, Suite 400a, Fairfield, NJ 07004-1592 | 2011-10-21 |
| 1982935987 | Luke R Carey | Physician Assistant | 695 Us Highway 46, Suite 400a, Fairfield, NJ 07004-1592 | 2010-01-15 |
| 1205075470 | Ricki M Henry | Specialist | 695 Us Highway 46, Suite 400a, Fairfield, NJ 07004-1592 | 2009-02-12 |
| 1023281664 | Carlo Opont | Physician Assistant | 695 Us Highway 46, Suite 400a, Fairfield, NJ 07004-1592 | 2008-04-03 |
| 1972710366 | Luisa Guena | Specialist | 695 Us Highway 46, Suite 400a, Fairfield, NJ 07004-1592 | 2007-05-17 |
| 1669689964 | Honora Valane | Specialist | 695 Us Highway 46, Suite 400a, Fairfield, NJ 07004-1592 | 2007-05-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912543695 | Dr. Mae J. Balaban & Associates LLC | Psychologist | 333 A U.S. Highway 46 W Ste 260, Fairfield, NJ 07004 | 2019-11-18 |
| 1477103547 | Kdds Too, Inc. | Community/Behavioral Health | 28 Dwight Place, Fairfield, NJ 07004 | 2019-09-19 |
| 1912487711 | Vela Diagnostics Usa Inc | Clinical Medical Laboratory | 353c Us Route 46, Suite 250, Fairfield, NJ 07004 | 2018-08-21 |
| 1285111864 | Advance Home Physical Therapy LLC | Physical Therapist | 9 Belair Dr, Fairfield, NJ 07004 | 2018-07-25 |
| 1063808962 | Homecare Rx Inc. | Pharmacy | 695 Us Hwy. 46, Ste. 100, Fairfield, NJ 07004 | 2015-04-08 |
| 1336544832 | Villo' Fiddler | Pharmacist | 632 Rt. 46 East, Fairfield, NJ 07004 | 2014-10-27 |
| 1093133746 | Simone Alicia Douge | Family Medicine | 700 Route 46 E Ste 450, Fairfield, NJ 07004 | 2014-03-31 |
| 1386905529 | Med Life LLC | Ambulance | 295 Route 46 West, Suite 201, Fairfield, NJ 07004 | 2012-06-05 |
| 1164792453 | Daniel Seth Greenbaum | Dentist | 592 Us Highway 46, Fairfield, NJ 07004 | 2012-01-04 |
| 1447529425 | Yelena Daysudov | Pharmacist | 180 Passaic Avenue, Fairfield, NJ 07004 | 2011-12-21 |
| Find all providers in zip 07004 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659523561 | Lara Beth Kokenos | Physician Assistant | 425 Post Rd Fl 2, Fairfield, CT 06824-6232 | 2008-10-22 |
| 1780607945 | Jennifer M Nori | Physician Assistant | 93 Nonopoge Rd, Fairfield, CT 06825-7219 | 2006-07-26 |
| 1073945267 | Kelly M. Pitzer | Physician Assistant | 3050 Mack Rd, Suite 200, Fairfield, OH 45014-5379 | 2013-07-30 |
| 1962787986 | Sweta G Dalsania | Physician Assistant | 695 Us Highway 46, Suite 400a, Fairfield, NJ 07004-1592 | 2011-10-21 |
| 1295978930 | Marjorie Claudine Francis | Physician Assistant | 695 Us Highway 46 Ste 400a, Fairfield, NJ 07004-1568 | 2009-04-10 |
| 1023281664 | Carlo Opont | Physician Assistant | 695 Us Highway 46, Suite 400a, Fairfield, NJ 07004-1592 | 2008-04-03 |
| 1336188127 | Matthew Donald Barr | Physician Assistant | 52 Beach Rd, Suite 207, Fairfield, CT 06824-6017 | 2006-06-06 |
| 1215982624 | Jill Wasserman Gulliford | Physician Assistant | 501 Kings Hwy E, Suite 112, Fairfield, CT 06825-4867 | 2006-05-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467062463 | Erica Josephine Lobuglio | Physician Assistant | 733 N Beers St Ste U3, Holmdel, NJ 07733-1513 | 2020-08-04 |
| 1407471493 | Angelice Grasso | Physician Assistant | 3 Holly Ln, Garfield, NJ 07026-3565 | 2020-06-15 |
| 1063036358 | Jaina Marie Lumkong | Physician Assistant | 905 Allwood Rd Ste 204, Clifton, NJ 07012-1946 | 2020-06-02 |
| 1740804384 | Allison Sy Tan | Physician Assistant | 10 Bahr Cir, Verona, NJ 07044-3200 | 2020-05-29 |
| 1114560851 | Brian Paul Leonhardt | Physician Assistant | 1113 Hospital Drive Professional Building East, Suite 100, Willingboro, NJ 08046 | 2019-10-25 |
| 1740830413 | Atara Hagler | Physician Assistant | 1500 Pleasant Valley Way Ste 101, West Orange, NJ 07052-2956 | 2019-09-16 |
| 1568943058 | Ekaterina M Rezvin | Physician Assistant | 80 Woodland Park Dr, Tenafly, NJ 07670-3028 | 2018-08-23 |
| 1225550353 | Kristen Cordiello | Physician Assistant | 1610 Route 88 Ste 203, Brick, NJ 08724-3018 | 2017-07-11 |
| 1710408232 | Angela Marie Freedman | Physician Assistant | 1 Riverview Plaza Multi Disciplinary Cancer Center, Red Bank, NJ 07701 | 2017-07-06 |
| 1063932259 | Matthew Gabriel | Physician Assistant | 25 Prospect Avernue, 2nd Floor, Hackensack, NJ 07601 | 2017-06-20 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.