Provider Demographics
NPI:1093776759
Name:GIANNAKOPOULOS, GEORGIOS (DO)
Entity Type:Individual
Prefix:
First Name:GEORGIOS
Middle Name:
Last Name:GIANNAKOPOULOS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 372
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-0372
Mailing Address - Country:US
Mailing Address - Phone:732-735-8237
Mailing Address - Fax:732-888-7381
Practice Address - Street 1:717 N BEERS ST
Practice Address - Street 2:SUITE 2E
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1524
Practice Address - Country:US
Practice Address - Phone:732-735-8237
Practice Address - Fax:732-888-7381
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA67697207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7823401Medicaid
NJ018218Medicare ID - Type Unspecified
NJ7823401Medicaid