Healthcare Provider Details

I. General information

NPI: 1245477660
Provider Name (Legal Business Name): EUNICE E L GEORGIADIS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EUNICE LEE N.P.

II. Dates (important events)

Enumeration Date: 01/08/2009
Last Update Date: 04/13/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 EAST 95TH STREET
NEW YORK NY
10128-4007
US

IV. Provider business mailing address

ADVANTAGECARE PHYSICIANS, PC 55 WATER STREET 2ND FLOOR CRED DEPT
NEW YORK NY
10041-0004
US

V. Phone/Fax

Practice location:
  • Phone: 212-996-8000
  • Fax: 212-423-3127
Mailing address:
  • Phone: 646-680-2888
  • Fax: 516-542-5556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number26NR10593500
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number334489
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: