Healthcare Provider Details

I. General information

NPI: 1104804368
Provider Name (Legal Business Name): GEORGE YIACHOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 12/03/2021
Certification Date: 12/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 FRANKLIN AVE
GARDEN CITY NY
11530-1613
US

IV. Provider business mailing address

1401 FRANKLIN AVE
GARDEN CITY NY
11530-1613
US

V. Phone/Fax

Practice location:
  • Phone: 516-877-2626
  • Fax: 516-877-0945
Mailing address:
  • Phone: 516-877-2626
  • Fax: 516-877-0945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME150292
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number196075
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: