Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 057889 | NY |
Y | 1223P0700X | Prosthodontist | 057889 | NY |
NPI | 1063813343 |
---|---|
Provider Name | Dr. Constantine Stavrinoudis |
First Address | Manhasset, NY 11030-3500 |
Second Address | Manhasset, NY 11030-3500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2014 |
Last Update Date | 14/02/2022 |