Individual provider Active NPI

Mirjana Barjaktarovic, MD, PHD

  • Endocrinology, Diabetes & Metabolism Physician
  • Bronx, NY
National Provider Identifier
1255959664
Registry record updated Jun 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
78894 Issued in CT
Practice address
130 W Kingsbridge Rd
Bronx, NY 10468-3904
Phone
(718) 584-9000
NPI assigned
Jul 12, 2020
Last updated
Jun 9, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 9, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 78894 CT Primary

Addresses

Primary practice location

130 W Kingsbridge Rd
Bronx, NY 10468-3904

Mailing address

130 W Kingsbridge Rd
Bronx, NY 10468-3904
Phone (718) 584-9000

Other practice location 1

111 Salem Tpke Ste 3
Norwich, CT 06360-7403
Phone (860) 892-6906

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250715000036 CT Practitioner - Endocrinology 3779944830 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Endocrinology
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The William W Backus HospitalGroup PAC ID 0749170645, 248 clinicians

Practice addresses (Care Compare)

111 Salem Tpke
Norwich, CT 06360-7403
Phone (860) 892-6906

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
The William W Backus Hospital CurrentSince Jul 1, 2025 Accepting new patients
William W Backus Hospital CurrentSince Jul 1, 2025 Accepting new patients
The William W Backus Hospital Past Accepting new patients

Locations

111 Salem Tpke
Norwich, CT 06360
Phone (860) 425-5900

111 Salem Tpke
Ste 3
Norwich, CT 06360
Phone (860) 892-6906

326 Washington St
Norwich, CT 06360
Phone (860) 701-0140

1290 Silas Deane Hwy
Wethersfield, CT 06109
Phone (860) 972-6977

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1594512000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749427200000",
    "number": "1255959664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 W KINGSBRIDGE RD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104683904",
            "telephone_number": "718-584-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 W KINGSBRIDGE RD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104683904",
            "telephone_number": "718-584-9000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 Salem Tpke Ste 3",
            "address_purpose": "LOCATION",
            "city": "Norwich",
            "state": "CT",
            "postal_code": "063607403",
            "country_code": "US",
            "telephone_number": "860-892-6906",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BARJAKTAROVIC",
        "first_name": "MIRJANA",
        "name_prefix": "Dr.",
        "credential": "MD, PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-12",
        "last_updated": "2025-06-09",
        "certification_date": "2025-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "CT",
            "license": "78894",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

Verify at the official NPI Registry.