Healthcare Provider Details

I. General information

NPI: 1720099724
Provider Name (Legal Business Name): VASSILIOS G. DIMOPOULOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 MONTAUK HWY
WEST ISLIP NY
11795-4403
US

IV. Provider business mailing address

380 MONTAUK HWY
WEST ISLIP NY
11795-4403
US

V. Phone/Fax

Practice location:
  • Phone: 631-482-9977
  • Fax: 631-422-4169
Mailing address:
  • Phone: 631-482-9977
  • Fax: 631-422-4169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number277247
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: