Healthcare Provider Details

I. General information

NPI: 1649224247
Provider Name (Legal Business Name): ANGELEKE SARIDAKIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 05/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 MASON AVE
STATEN ISLAND NY
10305-3408
US

IV. Provider business mailing address

256 MASON AVE
STATEN ISLAND NY
10305-3408
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-6260
  • Fax: 718-226-1259
Mailing address:
  • Phone: 718-226-6260
  • Fax: 718-226-1259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number181376
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: