Provider Demographics
NPI:1467452797
Name:PAPAMITSAKIS, NIKOLAOS I H (MD)
Entity Type:Individual
Prefix:
First Name:NIKOLAOS
Middle Name:I H
Last Name:PAPAMITSAKIS
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 1:450 CLARKSON AVE STE B6-314
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2012
Mailing Address - Country:US
Mailing Address - Phone:718-221-5188
Mailing Address - Fax:718-221-5761
Practice Address - Street 1:450 CLARKSON AVE STE B6-314
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2012
Practice Address - Country:US
Practice Address - Phone:718-270-1259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC294092084N0400X
NJ25MA075056002084N0400X
MI43010731052084N0400X
NY2586312084N0400X, 2084V0102X
CT651562084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC294096Medicaid
NJ9056505Medicaid
SC294096Medicaid
SCG72183Medicare UPIN
SCG72183Medicare UPIN