=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235739566
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | S TSOUMPARIOTIS DPM PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2020
-----------------------------------------------------
Last Update Date | 12/18/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7901 MYRTLE AVE
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11385-7441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-381-2300
-----------------------------------------------------
Fax | 718-381-0222
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7901 MYRTLE AVE
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11385-7441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-381-2300
-----------------------------------------------------
Fax | 718-381-0222
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SPYROS TSOUMPARIOTIS
-----------------------------------------------------
Credential | DPM
-----------------------------------------------------
Telephone | 917-749-3713
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------