Provider Demographics
NPI:1235103243
Name:STOUPAKIS, GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:STOUPAKIS
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:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07602-0067
Mailing Address - Country:US
Mailing Address - Phone:201-343-7001
Mailing Address - Fax:201-343-7232
Practice Address - Street 1:5 SUMMIT AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-8503
Practice Address - Country:US
Practice Address - Phone:201-343-7001
Practice Address - Fax:201-343-7232
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07271800207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0075639Medicaid