MEDICARE: DEMETRIOS ECONOPOULY, DPM PC

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	332B00000X	Durable Medical Equipment & Medical Supplies	25MD00208800	NJ
2	213ES0103X	Foot & Ankle Surgery Podiatrist	25MD00208800	NJ

General Provider Information

NPI Number	:	1467621391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEMETRIOS ECONOPOULY, DPM PC

Provider Business Mailing Address
First Line	:	1906 KENNEDY BLVD
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-2013
Country	:	US
Telephone Number	:	201-863-5383
Fax Number	:	201-863-3055

Provider Business Practice Location Address
First Line	:	1906 KENNEDY BLVD
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-2013
Country	:	US
Telephone Number	:	201-863-5383
Fax Number	:	201-863-3055

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DEMETRIOS S ECONOPOULY
Credential	:	DPM
Telephone Number	:	201-863-5383

Provider Enumeration Date	:	02/25/2008
Last Update Date	:	02/25/2008

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