Healthcare Provider Details

I. General information

NPI: 1386916963
Provider Name (Legal Business Name): CHRISTOS D. DOSSA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2012
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 HYLAN BLVD
STATEN ISLAND NY
10306-3117
US

IV. Provider business mailing address

2460 HYLAN BLVD
STATEN ISLAND NY
10306-3117
US

V. Phone/Fax

Practice location:
  • Phone: 718-667-7927
  • Fax: 718-667-7897
Mailing address:
  • Phone: 718-667-7927
  • Fax: 718-667-7897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number193806
License Number StateNY

VIII. Authorized Official

Name: DR. CHRISTOS D DOSSA
Title or Position: DOCTOR
Credential: M.D.
Phone: 718-667-7927