1790730026 NPI number — MANOLIS THEODORE TSATSAS M.D.

Table of content: MANOLIS THEODORE TSATSAS M.D. (NPI 1790730026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790730026 NPI number — MANOLIS THEODORE TSATSAS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TSATSAS
Provider First Name:
MANOLIS
Provider Middle Name:
THEODORE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1790730026
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 27842
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10087-7842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-670-1651
Provider Business Mailing Address Fax Number:
516-437-4167

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16303 HORACE HARDING EXPY
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
FRESH MEADOWS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11365-1449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-670-1170
Provider Business Practice Location Address Fax Number:
516-437-4167
Provider Enumeration Date:
05/24/2006

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: 207VX0201X , with the licence number:  203209 , 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: 01860159 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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