Provider Demographics
NPI:1407094410
Name:KANGADIS, SOCRATES THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:SOCRATES THOMAS
Middle Name:
Last Name:KANGADIS
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 1:517 PARSONS BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1024
Mailing Address - Country:US
Mailing Address - Phone:718-746-1396
Mailing Address - Fax:
Practice Address - Street 1:2309 31ST ST
Practice Address - Street 2:UNIT # 3
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2767
Practice Address - Country:US
Practice Address - Phone:718-204-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY258353207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03268095Medicaid
NYG300020175Medicare UPIN