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General NPI Number Information
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NPI Number | 1396485264
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Entity Type | Individual
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Provider Name | GEORGIA THEODORA XENOPHONTOS
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Gender | Female
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Dates
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Enumeration Date | 03/30/2022
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | 1165 NORTHERN BLVD STE 301
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City | MANHASSET
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State | NY
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Zip | 11030-3048
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Country | US
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Telephone | 516-365-4545
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Fax | 516-365-7111
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Provider Business Mailing Address
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Address Line | 1165 NORTHERN BLVD
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City | MANHASSET
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State | NY
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Zip | 11030-3039
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Country | US
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Telephone | 515-316-4545
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Fax | 515-365-7111
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 007466
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License Number State | NY
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