Provider Demographics
NPI:1134297542
Name:MANTZOUKAS, ARGIRIOS
Entity Type:Individual
Prefix:DR
First Name:ARGIRIOS
Middle Name:
Last Name:MANTZOUKAS
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:ARIS
Other - Middle Name:
Other - Last Name:MANTZOUKAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:8607 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4003
Mailing Address - Country:US
Mailing Address - Phone:718-266-1986
Mailing Address - Fax:718-266-2203
Practice Address - Street 1:8635 21ST AVE APT 1C
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-4033
Practice Address - Country:US
Practice Address - Phone:171-826-6198
Practice Address - Fax:718-266-2203
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006060213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVO8202Medicare UPIN
NY07499Medicare ID - Type Unspecified