1649577446 NPI number — MISS KALLIOPE JANE MORIKIS DO

Table of content: MISS KALLIOPE JANE MORIKIS DO (NPI 1649577446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649577446 NPI number — MISS KALLIOPE JANE MORIKIS DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MORIKIS
Provider First Name:
KALLIOPE
Provider Middle Name:
JANE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORIKIS
Provider Other First Name:
KALLI
Provider Other Middle Name:
JANE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1649577446
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
70 DUBOIS ST
Provider Second Line Business Mailing Address:
HOSPITALIST DEPT
Provider Business Mailing Address City Name:
NEWBURGH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12550-4851
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-568-2564
Provider Business Mailing Address Fax Number:
845-568-2851

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 DUBOIS ST
Provider Second Line Business Practice Location Address:
HOSPITALIST DEPT
Provider Business Practice Location Address City Name:
NEWBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12550-4851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-568-2564
Provider Business Practice Location Address Fax Number:
845-568-2851
Provider Enumeration Date:
02/15/2011

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: 207R00000X , with the licence number:  265857 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: 265857 , 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: 03516832 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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