Healthcare Provider Details

I. General information

NPI: 1326309089
Provider Name (Legal Business Name): JAMES JOHN TSIAKOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 05/19/2022
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 OLD COUNTRY RD SUITE 102
PLAINVIEW NY
11803-4942
US

IV. Provider business mailing address

875 OLD COUNTRY RD SUITE 102
PLAINVIEW NY
11803-4942
US

V. Phone/Fax

Practice location:
  • Phone: 516-935-8877
  • Fax: 516-935-8877
Mailing address:
  • Phone: 516-935-8877
  • Fax: 516-935-8877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number265280
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: