Provider Demographics
NPI:1356626956
Name:PAUL C LADOPOULOS MD PC
Entity Type:Organization
Organization Name:PAUL C LADOPOULOS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PC
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:C
Authorized Official - Last Name:LADOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-274-6636
Mailing Address - Street 1:30-33 36TH STREET
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-4704
Mailing Address - Country:US
Mailing Address - Phone:718-274-6636
Mailing Address - Fax:718-274-9080
Practice Address - Street 1:3033 36TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-4704
Practice Address - Country:US
Practice Address - Phone:718-274-6636
Practice Address - Fax:718-274-9080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1722262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty