Healthcare Provider Details

I. General information

NPI: 1033105564
Provider Name (Legal Business Name): GUS KATSIGIORGIS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 BROADWAY
HEWLETT NY
11557-9998
US

IV. Provider business mailing address

PO BOX 360
HEWLETT NY
11557-9998
US

V. Phone/Fax

Practice location:
  • Phone: 516-374-6838
  • Fax: 516-374-2362
Mailing address:
  • Phone: 516-374-6838
  • Fax: 516-374-2362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number234244
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: