Provider Demographics
NPI:1316381197
Name:KOTSAFTIS, ANTONIOS (PHD)
Entity Type:Individual
Prefix:
First Name:ANTONIOS
Middle Name:
Last Name:KOTSAFTIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2232 24TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-3452
Mailing Address - Country:US
Mailing Address - Phone:347-885-5997
Mailing Address - Fax:
Practice Address - Street 1:2232 24TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-3452
Practice Address - Country:US
Practice Address - Phone:347-885-5997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013764103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical