Healthcare Provider Details

I. General information

NPI: 1710241237
Provider Name (Legal Business Name): MR. DIMITRIOS GIOUZEPIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 06/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4338 194TH ST HOUSE
FLUSHING NY
11358-3517
US

IV. Provider business mailing address

4338 194TH ST HOUSE
FLUSHING NY
11358-3517
US

V. Phone/Fax

Practice location:
  • Phone: 347-392-8070
  • Fax:
Mailing address:
  • Phone: 347-392-8070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number743498
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: