Healthcare Provider Details

I. General information

NPI: 1083661987
Provider Name (Legal Business Name): DEMETRIOS GEORGIOU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2318 31ST ST
ASTORIA NY
11105-2765
US

IV. Provider business mailing address

2318 31ST ST
ASTORIA NY
11105-2765
US

V. Phone/Fax

Practice location:
  • Phone: 718-204-2200
  • Fax: 718-204-2218
Mailing address:
  • Phone: 718-204-2200
  • Fax: 718-204-2218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number166154-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number166154
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: