MEDICARE: NICHOLAS GIANOUKAKIS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	216791	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275574741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS GIANOUKAKIS M.D.

Provider Business Mailing Address
First Line	:	26 BLUEBIRD DR
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-1808
Country	:	US
Telephone Number	:	848-333-3366
Fax Number	:

Provider Business Practice Location Address
First Line	:	26 BLUEBIRD DR
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577-1808
Country	:	US
Telephone Number	:	848-333-3366
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	03/07/2023

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