Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | 299922 | NY |
NPI | 1205281409 |
---|---|
Provider Name | Dr. Mina Ekladios |
First Address | Arlington, VA 22201-2232 |
Second Address | Stony Brook, NY 11794-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2016 |
Last Update Date | 29/07/2019 |