Provider Demographics
NPI:1417032863
Name:TSOUMPARIOTIS, SPYROS (DPM)
Entity Type:Individual
Prefix:
First Name:SPYROS
Middle Name:
Last Name:TSOUMPARIOTIS
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 1:79-01 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385
Mailing Address - Country:US
Mailing Address - Phone:718-381-2300
Mailing Address - Fax:718-381-0222
Practice Address - Street 1:79-01 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385
Practice Address - Country:US
Practice Address - Phone:718-381-2300
Practice Address - Fax:718-381-0222
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005288213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
100157OtherELDERPLAN
1742076OtherUNITED HEALTHCARE
6201419OtherGHI
NY01765677Medicaid
P630868OtherOXFORD
37175POtherHIP
P9410OtherBLUE CROSS BLUE SHIELD
NY01765677Medicaid