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General NPI Number Information
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NPI Number | 1679710115
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Entity Type | Organization
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Legal Business Name | ARIKOSTADARAS,M.D.,P.C.
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Dates
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Enumeration Date | 01/20/2009
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Last Update Date | 03/11/2009
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Provider Practice Location Address
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Address Line | 2318 31ST ST SUITE 220
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City | ASTORIA
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State | NY
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Zip | 11105-2892
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Country | US
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Telephone | 718-721-4440
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Fax | 718-907-7932
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Provider Business Mailing Address
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Address Line | 2510 38TH ST
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City | ASTORIA
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State | NY
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Zip | 11103-4224
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Country | US
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Telephone | 718-721-4440
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Fax | 718-907-7932
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ARI KOSTADARAS
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Credential | M.D.
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Telephone | 718-721-4440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 189511
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License Number State | NY
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