Healthcare Provider Details

I. General information

NPI: 1730364050
Provider Name (Legal Business Name): MR. GEORGE JOHN DARIOTIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2008
Last Update Date: 01/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 BELL BLVD
BAYSIDE NY
11361-2061
US

IV. Provider business mailing address

24632 VAN ZANDT AVE
DOUGLASTON NY
11362-1239
US

V. Phone/Fax

Practice location:
  • Phone: 718-224-2606
  • Fax: 718-224-8083
Mailing address:
  • Phone: 718-926-5674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number048578
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: