Provider Demographics
NPI:1063458461
Name:VARTHOLOMEOS, NIKOLAOS (PT)
Entity Type:Individual
Prefix:
First Name:NIKOLAOS
Middle Name:
Last Name:VARTHOLOMEOS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:877 STEWART AVE STE 17
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4803
Mailing Address - Country:US
Mailing Address - Phone:516-222-1416
Mailing Address - Fax:516-222-1649
Practice Address - Street 1:877 STEWART AVE STE 17
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4803
Practice Address - Country:US
Practice Address - Phone:516-222-1416
Practice Address - Fax:516-222-1649
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026172-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ11K8XVPZ1Medicare PIN