Healthcare Provider Details

I. General information

NPI: 1497108575
Provider Name (Legal Business Name): IOULIA GOURARI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 09/15/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 BAINBRIDGE AVE
BRONX NY
10467-2403
US

IV. Provider business mailing address

426 E 81ST ST APT 4D
NEW YORK NY
10028-5857
US

V. Phone/Fax

Practice location:
  • Phone: 718-515-2330
  • Fax:
Mailing address:
  • Phone: 917-864-7170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number300756
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number300756
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: