Provider Demographics
NPI:1366480527
Name:ZOUZIAS, DIMITRIS C (MD)
Entity Type:Individual
Prefix:
First Name:DIMITRIS
Middle Name:C
Last Name:ZOUZIAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 UNION ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3049
Mailing Address - Country:US
Mailing Address - Phone:718-445-1550
Mailing Address - Fax:718-445-2843
Practice Address - Street 1:3202 UNION ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-3049
Practice Address - Country:US
Practice Address - Phone:718-445-1550
Practice Address - Fax:718-445-2843
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05020700207N00000X
NY174330207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0365106Medicaid
441485B8AMedicare ID - Type Unspecified
NJ0365106Medicaid