Healthcare Provider Details

I. General information

NPI: 1407419989
Provider Name (Legal Business Name): CHRISTOFOROS KOUMAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2019
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3379 CROMPOND RD
YORKTOWN HEIGHTS NY
10598-3605
US

IV. Provider business mailing address

3379 CROMPOND RD
YORKTOWN HEIGHTS NY
10598-3605
US

V. Phone/Fax

Practice location:
  • Phone: 914-849-7060
  • Fax: 914-849-7062
Mailing address:
  • Phone: 914-849-7060
  • Fax: 914-849-7062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number308498
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number308498
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number308498
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: