Provider Demographics
NPI:1174652655
Name:TSAVARIS, GEORGE A (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:A
Last Name:TSAVARIS
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 1:236 E 106TH ST
Mailing Address - Street 2:1 ST FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-4058
Mailing Address - Country:US
Mailing Address - Phone:212-534-3608
Mailing Address - Fax:
Practice Address - Street 1:236 E 106TH ST
Practice Address - Street 2:1 ST FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-4058
Practice Address - Country:US
Practice Address - Phone:212-534-3608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY141824207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0031958OtherGHI
NY00460875Medicaid
NYB11963Medicare UPIN
NY0031958OtherGHI