Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 256948 | NY |
Y | 208600000X | Surgeon | 256948 | NY |
N | 2086S0122X | Plastic and Reconstructive Surgery | 002733 | NY |
NPI | 1003992926 |
---|---|
Provider Name | Mr. Dimitri J Koumanis |
First Address | Glens Falls, NY 12801-4432 |
Second Address | Glens Falls, NY 12801-4432 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 25/02/2016 |