Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | MA67697 | NJ |
NPI | 1093776759 |
---|---|
Provider Name | Georgios Giannakopoulos |
First Address | Holmdel, NJ 07733-0372 |
Second Address | Holmdel, NJ 07733-1524 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 23/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7823401 | (05) | NJ |
G80133 | (02) | NJ |