Provider Demographics
NPI:1164463857
Name:SIDERIAS, IOANIS C (MD)
Entity Type:Individual
Prefix:
First Name:IOANIS
Middle Name:C
Last Name:SIDERIAS
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 1:5600 SUNRISE HWY
Mailing Address - Street 2:STAT HEALTH
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-1017
Mailing Address - Country:US
Mailing Address - Phone:631-563-7828
Mailing Address - Fax:631-265-5128
Practice Address - Street 1:5600 SUNRISE HWY
Practice Address - Street 2:STAT HEALTH
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-1017
Practice Address - Country:US
Practice Address - Phone:631-563-7828
Practice Address - Fax:631-265-5128
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217866207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I01939Medicare UPIN
NY925V51Medicare ID - Type Unspecified