Healthcare Provider Details

I. General information

NPI: 1417032863
Provider Name (Legal Business Name): SPYROS TSOUMPARIOTIS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79-01 MYRTLE AVE
GLENDALE NY
11385
US

IV. Provider business mailing address

79-01 MYRTLE AVE
GLENDALE NY
11385
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 NumberN005288
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: