Provider Demographics
NPI:1053478545
Name:PAPAPETROU, GUS CHRISTOS (PHD)
Entity Type:Individual
Prefix:DR
First Name:GUS
Middle Name:CHRISTOS
Last Name:PAPAPETROU
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11510 QUEENS BLVD
Mailing Address - Street 2:STE UL4
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7060
Mailing Address - Country:US
Mailing Address - Phone:718-544-8454
Mailing Address - Fax:201-767-6092
Practice Address - Street 1:11510 QUEENS BLVD
Practice Address - Street 2:STE UL4
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7060
Practice Address - Country:US
Practice Address - Phone:718-544-8454
Practice Address - Fax:201-767-6092
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7633103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY147100OtherVALUE OPTIONS
NY00845450Medicaid
NYP622131OtherOXFORD
NY00845450Medicaid