1245477660 NPI number — EUNICE E L GEORGIADIS N.P.

Table of content: EUNICE E L GEORGIADIS N.P. (NPI 1245477660)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245477660 NPI number — EUNICE E L GEORGIADIS N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GEORGIADIS
Provider First Name:
EUNICE
Provider Middle Name:
E L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEE
Provider Other First Name:
EUNICE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
N.P.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245477660
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ADVANTAGECARE PHYSICIANS, PC
Provider Second Line Business Mailing Address:
55 WATER STREET 2ND FLOOR CRED DEPT
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10041-0004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-680-2888
Provider Business Mailing Address Fax Number:
516-542-5556

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
215 EAST 95TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10128-4007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-996-8000
Provider Business Practice Location Address Fax Number:
212-423-3127
Provider Enumeration Date:
01/08/2009

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: 163WC1500X , with the licence number:  26NR10593500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 334489 , 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)





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