Healthcare Provider Details

I. General information

NPI: 1891797502
Provider Name (Legal Business Name): DEMETRIOS KARIDES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date: 03/22/2006
Reactivation Date: 03/28/2006

III. Provider practice location address

14 SOUNDVIEW DR
BAYVILLE NY
11709-1114
US

IV. Provider business mailing address

14 SOUNDVIEW DR
BAYVILLE NY
11709-1114
US

V. Phone/Fax

Practice location:
  • Phone: 718-204-7821
  • Fax:
Mailing address:
  • Phone: 718-204-7821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number210635
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: