Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 104988 | NY |
Y | 111NI0900X | Internist | 104988 | NY |
NPI | 1992939342 |
---|---|
Provider Name | Mr. Athanassios Perdios |
First Address | Staten Island, NY 10304 |
Second Address | Staten Island, NY 10304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2009 |
Last Update Date | 13/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00182976 | (05) | NY |
1317843 | (02) | NY |