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General NPI Number Information
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NPI Number | 1760994347
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Entity Type | Organization
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Legal Business Name | VASOS ERACLEOUS, DDS
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Dates
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Enumeration Date | 11/03/2017
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Last Update Date | 11/03/2017
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Provider Practice Location Address
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Address Line | 2917 ASTORIA BLVD
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City | ASTORIA
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State | NY
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Zip | 11102-1741
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Country | US
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Telephone | 718-728-5759
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Fax | 718-204-8786
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Provider Business Mailing Address
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Address Line | 2917 ASTORIA BLVD
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City | ASTORIA
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State | NY
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Zip | 11102-1741
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Country | US
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Telephone | 718-728-5759
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Fax | 718-204-8786
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Authorized Official
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Title or Position | PRESIDENT/ DOCTOR
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Name | DR. VASOS ERACLEOUS
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Credential |
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Telephone | 718-728-5759
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 50191
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License Number State | NY
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