Provider Demographics
NPI:1194820845
Name:SARANTAKOS, STAVROS (MD)
Entity Type:Individual
Prefix:
First Name:STAVROS
Middle Name:
Last Name:SARANTAKOS
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 1:3 HATFIELD LANE
Mailing Address - Street 2:VALLEY BEHAVIORAL MEDICINE SUITE 1
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-6732
Mailing Address - Country:US
Mailing Address - Phone:845-291-7480
Mailing Address - Fax:845-294-3785
Practice Address - Street 1:3 HATFIELD LANE
Practice Address - Street 2:VALLEY BEHAVIORAL MEDICINE SUITE 1
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-6732
Practice Address - Country:US
Practice Address - Phone:845-291-7480
Practice Address - Fax:845-294-3785
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1294662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B14084Medicare UPIN
NY324471Medicare PIN