Provider Demographics
NPI:1275540767
Name:TROULAKIS, EMMANUEL FRANK
Entity Type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:FRANK
Last Name:TROULAKIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3018 37TH ST
Mailing Address - Street 2:EMMANUEL F TROULAKIS MD
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3809
Mailing Address - Country:US
Mailing Address - Phone:718-278-0100
Mailing Address - Fax:718-278-1143
Practice Address - Street 1:3018 37TH ST
Practice Address - Street 2:EMMANUEL F TROULAKIS MD
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3809
Practice Address - Country:US
Practice Address - Phone:718-278-0100
Practice Address - Fax:718-278-1143
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137457207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00669874Medicaid
NY00669874Medicaid
B14237Medicare UPIN