Provider Demographics
NPI:1376501296
Name:KALONAROS, VASILIOS (MD)
Entity Type:Individual
Prefix:MR
First Name:VASILIOS
Middle Name:
Last Name:KALONAROS
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 1:50 KARL AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2744
Mailing Address - Country:US
Mailing Address - Phone:631-239-1677
Mailing Address - Fax:631-724-3967
Practice Address - Street 1:50 KARL AVE STE 301
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2744
Practice Address - Country:US
Practice Address - Phone:631-239-1677
Practice Address - Fax:631-724-3967
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183593207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW34601OtherGROUP UPIN
NY01201490Medicaid
NYE62473Medicare UPIN
NY64F831Medicare ID - Type Unspecified