Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | N004647 | NY |
Y | 222Z00000X | Podiatrist | N004647 | NY |
N | 213EP0504X | Public Medicine | N004647 | NY |
N | 213EP1101X | Primary Podiatric Medicine | N004647 | NY |
N | 111NR0200X | Radiology | N004647 | NY |
N | 213ER0200X | Radiology | N004647 | NY |
N | 2081S0010X | Sports Medicine | N004647 | NY |
N | 213ES0000X | Sports Medicine | N004647 | NY |
N | 213ES0131X | Foot Surgery | N004647 | NY |
NPI | 1376518548 |
---|---|
Provider Name | Dr. George Vasiliadis |
First Address | Tonawanda, NY 14150-3334 |
Second Address | Tonawanda, NY 14150-3334 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2006 |
Last Update Date | 18/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00010257301 | UNIVERA HEALTHCARE (01) | NY |
000510938003 | BC/ BS OF WNY (01) | NY |
0076008 | GROUP HEALTH (01) | NY |
01195573 | (05) | NY |
040426002701 | FIDELIS CARE (01) | NY |
8990088 | INDEPENDENT HEALTH (01) | NY |
U01836 | (02) | NY |
Y017440 | TRICARE/ CHAMPUS (01) | NY |