Healthcare Provider Details

I. General information

NPI: 1457490963
Provider Name (Legal Business Name): DEMETRIOS MARKOUIZOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/28/2021
Certification Date: 07/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3014 37TH ST
ASTORIA NY
11103-3809
US

IV. Provider business mailing address

3014 37TH ST
ASTORIA NY
11103-3809
US

V. Phone/Fax

Practice location:
  • Phone: 718-278-9500
  • Fax: 718-278-2430
Mailing address:
  • Phone: 718-278-9500
  • Fax: 718-278-2430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number170828
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number170828
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: