Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | N004604 | NY |
N | 222Z00000X | Podiatrist | N004604 | NY |
N | 213EP1101X | Primary Podiatric Medicine | N004604 | NY |
N | 2081S0010X | Sports Medicine | N004604 | NY |
N | 213ES0000X | Sports Medicine | N004604 | NY |
Y | 213ES0131X | Foot Surgery | N004604 | NY |
NPI | 1225032097 |
---|---|
Provider Name | Dr. John Tsouris |
First Address | Lake Grove, NY 11755-1000 |
Second Address | Lake Grove, NY 11755-1000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2005 |
Last Update Date | 16/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U11181 | (02) | NY |