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General NPI Number Information
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NPI Number | 1356626956
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Entity Type | Organization
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Legal Business Name | PAUL C LADOPOULOS MD PC
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Dates
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Enumeration Date | 10/14/2011
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Last Update Date | 10/14/2011
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Provider Practice Location Address
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Address Line | 3033 36TH ST
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City | ASTORIA
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State | NY
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Zip | 11103-4704
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Country | US
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Telephone | 718-274-6636
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Fax | 718-274-9080
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Provider Business Mailing Address
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Address Line | 30-33 36TH STREET
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City | ASTORIA
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State | NY
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Zip | 11103-4704
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Country | US
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Telephone | 718-274-6636
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Fax | 718-274-9080
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Authorized Official
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Title or Position | PC
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Name | DR. PAUL C LADOPOULOS
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Credential | M.D.
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Telephone | 718-274-6636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 172226
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License Number State | NY
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