Healthcare Provider Details

I. General information

NPI: 1235762246
Provider Name (Legal Business Name): DIMOSTHENIS PANDIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 5TH AVE # GP2W
NEW YORK NY
10029-6503
US

IV. Provider business mailing address

1190 5TH AVE # 1028
NEW YORK NY
10029-6503
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-8223
  • Fax: 212-659-6818
Mailing address:
  • Phone: 212-241-8223
  • Fax: 212-659-6818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: