1417032863 NPI number — SPYROS TSOUMPARIOTIS DPM

Table of content: SPYROS TSOUMPARIOTIS DPM (NPI 1417032863)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417032863 NPI number — SPYROS TSOUMPARIOTIS DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TSOUMPARIOTIS
Provider First Name:
SPYROS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417032863
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
79-01 MYRTLE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11385
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-381-2300
Provider Business Mailing Address Fax Number:
718-381-0222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
79-01 MYRTLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-381-2300
Provider Business Practice Location Address Fax Number:
718-381-0222
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  N005288 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100157 . This is a "ELDERPLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1742076 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6201419 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01765677 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P630868 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 37175P . This is a "HIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: P9410 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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