Healthcare Provider Details

I. General information

NPI: 1326237827
Provider Name (Legal Business Name): EVANGELIA KONTAKIS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 OLD COUNTRY RD
PLAINVIEW NY
11803-6502
US

IV. Provider business mailing address

277 BOW DR
HAUPPAUGE NY
11788-1626
US

V. Phone/Fax

Practice location:
  • Phone: 516-931-3988
  • Fax:
Mailing address:
  • Phone: 646-425-0823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number01207701
License Number StateNY

VII. Legacy identifiers

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

# 1
Identifier01207701
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerNYS LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: