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General NPI Number Information
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NPI Number | 1861929861
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Entity Type | Organization
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Legal Business Name | THEOFANIS MITSINIKOS, DO, PC
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Dates
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Enumeration Date | 05/22/2017
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Last Update Date | 05/22/2017
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Provider Practice Location Address
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Address Line | 2500 NESCONSET HWY BLDG 3C
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City | STONY BROOK
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State | NY
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Zip | 11790-2551
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Country | US
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Telephone | 631-751-2400
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Fax | 631-751-8323
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Provider Business Mailing Address
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Address Line | 2500 NESCONSET HWY BLDG 3C
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City | STONY BROOK
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State | NY
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Zip | 11790-2551
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. THEOFANIS MITSINIKOS
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Credential | DO
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Telephone | 631-751-2400
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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 | 235458
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License Number State | NY
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