Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 234244 | NY |
NPI | 1033105564 |
---|---|
Provider Name | Mr. Gus Katsigiorgis |
First Address | Hewlett, NY 11557-9998 |
Second Address | Hewlett, NY 11557-9998 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2005 |
Last Update Date | 08/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I26392 | (02) |