Provider Demographics
NPI:1083750426
Name:IOANNOU, IOANNIS (MS)
Entity Type:Individual
Prefix:
First Name:IOANNIS
Middle Name:
Last Name:IOANNOU
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1476 163RD ST
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-2913
Mailing Address - Country:US
Mailing Address - Phone:718-767-3296
Mailing Address - Fax:718-458-1367
Practice Address - Street 1:7420 25TH AVE
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370-1428
Practice Address - Country:US
Practice Address - Phone:718-350-3171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001907-1237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00667758Medicaid
NYG40001449Medicare PIN