Provider Demographics
NPI:1245398122
Name:PANAYOTIDIS, GEORGE YORGO (RPT)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:YORGO
Last Name:PANAYOTIDIS
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 RIVERSIDE DR
Mailing Address - Street 2:SUITE 1 B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5204
Mailing Address - Country:US
Mailing Address - Phone:212-866-1181
Mailing Address - Fax:212-864-3947
Practice Address - Street 1:276 RIVERSIDE DR
Practice Address - Street 2:SUITE 1 B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5204
Practice Address - Country:US
Practice Address - Phone:212-866-1181
Practice Address - Fax:212-864-3947
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7941225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ54121Medicare ID - Type Unspecified