Healthcare Provider Details

I. General information

NPI: 1932605979
Provider Name (Legal Business Name): STERGIANI AGORASTOS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8268 164TH ST STE P113
JAMAICA NY
11432-1121
US

IV. Provider business mailing address

64 ONEIDA AVE
SOUTH SETAUKET NY
11720-1126
US

V. Phone/Fax

Practice location:
  • Phone: 718-883-4500
  • Fax:
Mailing address:
  • Phone: 631-834-2309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number309826-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: