MEDICARE: DR. ELEONORA GOUDIS 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	207R00000X	Internal Medicine Physician	203589	NY

General Provider Information

NPI Number	:	1407129075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELEONORA GOUDIS M.D.

Provider Business Mailing Address
First Line	:	120 E 87TH ST
Second Line	:	R22CD
City	:	NEW YORK
State	:	NY
Zip	:	10128-1116
Country	:	US
Telephone Number	:	203-273-0969
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 E 87TH ST
Second Line	:	R22CD
City	:	NEW YORK
State	:	NY
Zip	:	10128-1116
Country	:	US
Telephone Number	:	203-273-0969
Fax Number	:

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

Provider Enumeration Date	:	02/13/2012
Last Update Date	:	02/13/2012

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