Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 220299 | NY |
NPI | 1003913682 |
---|---|
Provider Name | Kostas Sideridis |
First Address | Syosset, NY 11791 |
Second Address | Syosset, NY 11791 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2006 |
Last Update Date | 02/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02760525 | (05) | NY |
I72004 | (02) |