MEDICARE: MRS. CHRISTINA MARIA AVDOULOS RPA

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	363AM0700X	Medical Physician Assistant	009108	NY

General Provider Information

NPI Number	:	1609816784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINA MARIA AVDOULOS RPA

Provider Business Mailing Address
First Line	:	100 PORT WASHINGTON BLVD
Second Line	:	SUITE G03
City	:	ROSLYN
State	:	NY
Zip	:	11576-1347
Country	:	US
Telephone Number	:	516-627-1155
Fax Number	:	516-365-6446

Provider Business Practice Location Address
First Line	:	100 PORT WASHINGTON BLVD
Second Line	:	SUITE G03
City	:	ROSLYN
State	:	NY
Zip	:	11576-1347
Country	:	US
Telephone Number	:	516-627-1155
Fax Number	:	516-365-6446

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	03/01/2011

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