Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 020698 | NY |
NPI | 1003366576 |
---|---|
Provider Name | Mr. Costantinos Stamboulis |
First Address | Whitestone, NY 11357-2542 |
Second Address | Astoria, NY 11102-1139 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2016 |
Last Update Date | 13/05/2021 |