Provider Demographics
NPI:1144200445
Name:ECONOPOULY, DEMETRIOS S (DPM)
Entity Type:Individual
Prefix:DR
First Name:DEMETRIOS
Middle Name:S
Last Name:ECONOPOULY
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 1:9226 KENNEDY BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-5312
Mailing Address - Country:US
Mailing Address - Phone:201-863-5383
Mailing Address - Fax:201-863-5744
Practice Address - Street 1:9226 KENNEDY BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-5312
Practice Address - Country:US
Practice Address - Phone:201-863-5383
Practice Address - Fax:201-863-5744
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00208800213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU33816Medicare UPIN
NJ139852Medicare ID - Type Unspecified