Healthcare Provider Details

I. General information

NPI: 1467621391
Provider Name (Legal Business Name): DEMETRIOS ECONOPOULY, DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 KENNEDY BLVD
UNION CITY NJ
07087-2013
US

IV. Provider business mailing address

1906 KENNEDY BLVD
UNION CITY NJ
07087-2013
US

V. Phone/Fax

Practice location:
  • Phone: 201-863-5383
  • Fax: 201-863-3055
Mailing address:
  • Phone: 201-863-5383
  • Fax: 201-863-3055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number25MD00208800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number25MD00208800
License Number StateNJ

VIII. Authorized Official

Name: DR. DEMETRIOS S ECONOPOULY
Title or Position: OWNER
Credential: DPM
Phone: 201-863-5383