Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 061934 | NY |
Y | 213EG0000X | General Practice | 061934 | NY |
NPI | 1003438938 |
---|---|
Provider Name | Dr. Konstantinos Stathopoulos |
First Address | Whitestone, NY 11357-3040 |
Second Address | Brooklyn, NY 11224-2501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2020 |
Last Update Date | 01/09/2021 |