Healthcare Provider Details

I. General information

NPI: 1811166341
Provider Name (Legal Business Name): SPYROS TSOUMPARIOTIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 09/18/2009
Certification Date:
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 NumberN005288
License Number StateNY

VIII. Authorized Official

Name: DR. SPYROS TSOUMPARIOTIS
Title or Position: DIRECTOR
Credential: D.P.M
Phone: 718-381-2300