MEDICARE: DR. ARISTIDES BASIL CODOYANNIS MD

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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	MA33916	NJ

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	:	1871565077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARISTIDES BASIL CODOYANNIS MD

Provider Business Mailing Address
First Line	:	13 GLENNON FARM LN
Second Line	:
City	:	LEBANON
State	:	NJ
Zip	:	08833-4504
Country	:	US
Telephone Number	:	973-476-2039
Fax Number	:	908-325-6343

Provider Business Practice Location Address
First Line	:	13 GLENNON FARM LN
Second Line	:
City	:	LEBANON
State	:	NJ
Zip	:	08833-4504
Country	:	US
Telephone Number	:	973-476-2039
Fax Number	:	908-325-6343

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

Provider Enumeration Date	:	02/02/2006
Last Update Date	:	07/05/2014

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