Healthcare Provider Details

I. General information

NPI: 1083750426
Provider Name (Legal Business Name): IOANNIS IOANNOU M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 AVENUE Z
BROOKLYN NY
11235-3800
US

IV. Provider business mailing address

1476 163RD ST
WHITESTONE NY
11357-2913
US

V. Phone/Fax

Practice location:
  • Phone: 718-745-6363
  • Fax:
Mailing address:
  • Phone: 917-683-1772
  • Fax: 718-458-1367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number001907-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: