Provider Demographics
NPI:1114085040
Name:TSIOURIS, SIMON JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:JOHN
Last Name:TSIOURIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:947 LINWOOD AVE
Mailing Address - Street 2:SUITE 2E
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-2939
Mailing Address - Country:US
Mailing Address - Phone:201-447-6468
Mailing Address - Fax:
Practice Address - Street 1:947 LINWOOD AVE
Practice Address - Street 2:SUITE 2E
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-2939
Practice Address - Country:US
Practice Address - Phone:201-447-6468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216282207RI0200X
NJ25MA09223900207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02587819Medicaid
NYI15327Medicare UPIN
NY2X3621Medicare ID - Type Unspecified