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General NPI Number Information
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NPI Number | 1821157058
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Entity Type | Individual
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Provider Name | PAVLOS I KYMISSIS MD
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Gender | Male
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7136 110TH ST SUITE 1A
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City | FOREST HILLS
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State | NY
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Zip | 11375-4852
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Country | US
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Telephone | 718-544-8506
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Fax | 914-674-4572
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Provider Business Mailing Address
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Address Line | 110 LAKE DR
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City | MANHASSET HILLS
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State | NY
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Zip | 11040-1137
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Country | US
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Telephone | 516-365-7214
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Fax | 516-365-7214
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 128862
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License Number State | NY
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