Provider Demographics
NPI:1275651911
Name:ASKLIPIOS MEDICAL GROUP, LLP
Entity Type:Organization
Organization Name:ASKLIPIOS MEDICAL GROUP, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PANAGIOTIS
Authorized Official - Middle Name:ANTONIOS
Authorized Official - Last Name:MANOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-267-1325
Mailing Address - Street 1:3016 30TH DRIVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-1874
Mailing Address - Country:US
Mailing Address - Phone:718-626-0707
Mailing Address - Fax:718-545-0333
Practice Address - Street 1:3016 30TH DR
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-1874
Practice Address - Country:US
Practice Address - Phone:718-626-0707
Practice Address - Fax:718-545-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01765695Medicaid
NY01765695Medicaid