Healthcare Provider Details

I. General information

NPI: 1235739566
Provider Name (Legal Business Name): S TSOUMPARIOTIS DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 12/18/2020
Certification Date: 12/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 MYRTLE AVE
GLENDALE NY
11385-7441
US

IV. Provider business mailing address

7901 MYRTLE AVE
GLENDALE NY
11385-7441
US

V. Phone/Fax

Practice location:
  • Phone: 718-381-2300
  • Fax: 718-381-0222
Mailing address:
  • Phone: 718-381-2300
  • Fax: 718-381-0222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: SPYROS TSOUMPARIOTIS
Title or Position: OWNER
Credential: DPM
Phone: 917-749-3713