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General NPI Number Information
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NPI Number | 1225032097
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Entity Type | Individual
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Provider Name | JOHN TSOURIS D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 10/16/2014
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Provider Practice Location Address
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Address Line | 2233 NESCONSET HWY SUITE 206
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City | LAKE GROVE
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State | NY
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Zip | 11755-1000
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Country | US
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Telephone | 631-751-4603
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Fax | 631-751-8166
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Provider Business Mailing Address
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Address Line | 2233 NESCONSET HWY SUITE 206
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City | LAKE GROVE
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State | NY
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Zip | 11755-1000
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Country | US
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Telephone | 631-751-4603
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Fax | 631-751-8166
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | N004604
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | N004604
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 213ES0000X
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Taxonomy Name | Sports Medicine Podiatrist
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License Number | N004604
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | N004604
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License Number State | NY
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