Provider Demographics
NPI:1003499534
Name:LOGOTHETIS, ELIAS G (DPM)
Entity Type:Individual
Prefix:
First Name:ELIAS
Middle Name:G
Last Name:LOGOTHETIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 LOWER NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-1806
Mailing Address - Country:US
Mailing Address - Phone:973-934-9704
Mailing Address - Fax:
Practice Address - Street 1:30 LOWER NOTCH RD
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07424-1806
Practice Address - Country:US
Practice Address - Phone:973-934-9704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program