Provider Demographics
NPI:1134145873
Name:KAROUTSOS, NICHOLAS FOTIOS (DPM)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:FOTIOS
Last Name:KAROUTSOS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22002 73RD AVE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2624
Mailing Address - Country:US
Mailing Address - Phone:718-464-8870
Mailing Address - Fax:718-464-8870
Practice Address - Street 1:22002 73RD AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-2624
Practice Address - Country:US
Practice Address - Phone:718-464-8870
Practice Address - Fax:718-464-8871
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005842213E00000X
NJ25MD00271600213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4784080001OtherMEDICARE NSC
NY02264184Medicaid
NJ9064907Medicaid
NY05430Medicare ID - Type UnspecifiedGHI MEDICARE
NY4784080001OtherMEDICARE NSC
NJ9064907Medicaid
NY02264184Medicaid