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General NPI Number Information
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NPI Number | 1851601728
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Entity Type | Organization
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Legal Business Name | O. GOUSSIS M.D. PC
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Dates
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Enumeration Date | 10/13/2010
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Last Update Date | 10/13/2010
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Provider Practice Location Address
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Address Line | 1010 NORTHERN BLVD STE 100
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City | GREAT NECK
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State | NY
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Zip | 11021-5306
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Country | US
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Telephone | 516-773-6301
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Fax | 516-773-6120
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Provider Business Mailing Address
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Address Line | 1010 NORTHERN BLVD STE 100
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City | GREAT NECK
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State | NY
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Zip | 11021-5306
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Country | US
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Telephone | 516-773-6301
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Fax | 516-773-6120
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Authorized Official
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Title or Position | MD
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Name | FRIXOS O GOUSSIS
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Credential | M.D.
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Telephone | 516-773-6301
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 144663
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License Number State | NY
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