Healthcare Provider Details

I. General information

NPI: 1164989604
Provider Name (Legal Business Name): MARIA HATZINIKOLAOU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 BELL BLVD
BAYSIDE NY
11361-2061
US

IV. Provider business mailing address

14544 3RD AVE
WHITESTONE NY
11357-1101
US

V. Phone/Fax

Practice location:
  • Phone: 718-224-2606
  • Fax:
Mailing address:
  • Phone: 347-956-0899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number063442
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: