Provider Demographics
NPI:1225015621
Name:BOTSOGLOU, NIKOLAOS (MD)
Entity Type:Individual
Prefix:DR
First Name:NIKOLAOS
Middle Name:
Last Name:BOTSOGLOU
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 1:2475 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-4551
Mailing Address - Country:US
Mailing Address - Phone:716-896-5922
Mailing Address - Fax:716-896-9272
Practice Address - Street 1:2475 HARLEM RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4551
Practice Address - Country:US
Practice Address - Phone:716-896-5922
Practice Address - Fax:716-896-9272
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1820411207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY239791Medicare PIN
NYF75623Medicare UPIN