Provider Demographics
NPI:1376942664
Name:KOTZIAS, GEORGIOS (DPM)
Entity Type:Individual
Prefix:DR
First Name:GEORGIOS
Middle Name:
Last Name:KOTZIAS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 625
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07660-0625
Mailing Address - Country:US
Mailing Address - Phone:201-255-4040
Mailing Address - Fax:201-255-4023
Practice Address - Street 1:80 E RTE 4 STE 100
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2647
Practice Address - Country:US
Practice Address - Phone:201-255-4040
Practice Address - Fax:201-255-4023
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-22
Last Update Date:2020-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00331900213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist